Raychelle Sheryl Wallace
Raychelle Sheryl Wallace is a Community/Behavioral Health Agency in Brandon, Florida. Practices as a sole proprietor. Licensed in Florida.
- Licensed in
- FL
- In the registry since
- 2021
- Specialties on file
- 6
Practice location Address checks out
673 W Lumsden RdBrandon, FL 33511-5911
Phone: (813) 798-0800
Fax: (813) 798-7800
Show map & directions
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Mental Health Counselor (primary) | Taxonomy 101YM0800X · Licence MH19813 (FL) |
|---|---|
| Community/Behavioral Health Agency | Taxonomy 251S00000X · Licence IMH18337 (FL) |
| Mental Health Clinic/Center (Including Community Mental Health Center) | Taxonomy 261QM0801X · Licence IMH18337 (FL) |
| Case Management Agency | Taxonomy 251B00000X · Licence IMH18337 (FL) |
| Adult Mental Health Clinic/Center | Taxonomy 261QM0850X · Licence IMH18337 (FL) |
| Adolescent and Children Mental Health Clinic/Center | Taxonomy 261QM0855X · Licence IMH18337 (FL) |
Record details
| NPI number | 1609464098 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | Yes |
| NPI enumerated | January 2, 2021 |
| Last updated in NPPES | August 14, 2023 |
| Certification date | August 12, 2023 |
| Mailing address | 11705 Boyette Rd, Pmb 430, Riverview, FL 33569 |
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