Justin Dale Wallace
Justin Dale Wallace is a Peer Specialist in Pryor, Oklahoma. Licensed in Oklahoma. Registered with an NPI since 2022.
- Licensed in
- OK
- In the registry since
- 2022
Practice location Address checks out
109 N Fairland StPryor, OK 74361-4205
Phone: (918) 925-1405
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Peer Specialist (primary) | Taxonomy 175T00000X · Licence 175T00000X (OK) |
|---|
Record details
| NPI number | 1578207072 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | April 21, 2022 |
| Last updated in NPPES | April 21, 2022 |
| Certification date | April 21, 2022 |
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