Chantel Lee Wallace
Chantel Lee Wallace is a Mental Health Counselor in Blackfoot, Idaho. Practices as a sole proprietor. Licensed in Idaho.
- Licensed in
- ID
- In the registry since
- 2024
Practice location Address checks out
581 N Ash StBlackfoot, ID 83221-2223
Phone: (208) 973-5077
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Specialties & licences
| Mental Health Counselor (primary) | Taxonomy 101YM0800X · Licence LMSW-43731 (ID) |
|---|
Record details
| NPI number | 1669234308 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | Yes |
| NPI enumerated | January 29, 2024 |
| Last updated in NPPES | January 29, 2024 |
| Certification date | January 28, 2024 |
| Mailing address | 581 N Ash St, Blackfoot, ID 83221-2223 |
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