Wallace, Myriah Dawn

Wallace, Myriah Dawn is an individual health care provider with primary practice located at 1211 Porter Wagoner Blvd , West Plains MO 65775-1826. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Wallace, Myriah Dawn can be contacted via phone (417) 257-6762.

Contact Information

Primary practice address
1211 Porter Wagoner Blvd West Plains MO 65775-1826
Phone: (417) 257-6762
Fax: (417) 257-5875
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 2011008967 Missouri

Profile Details

NPI number 1184921496
LBN Legal business name Wallace, Myriah Dawn
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 23rd, 2011
Last updated Apr 14th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184921496 NPPES
Missouri MEDICAID 2011008967

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