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Mr. Terry Eugene Wallace, CADC
Addiction (Substance Use Disorder) Counselor in Idabel, Oklahoma
NPI 1831304922

Terry Eugene Wallace is an Addiction (Substance Use Disorder) Counselor based in Haworth, OK and is specialized in Addiction (Substance Use Disorder). Terry Eugene Wallace practices in Idabel, OK and has the professional credentials of CADC. The NPI Number for Terry Eugene Wallace is 1831304922 and holds a License No. 71 (Oklahoma).

The current practice location address for Terry Eugene Wallace is 104 Ne Avenue A, Idabel, OK and can be reached out via phone at 580-286-3301.

Location: 104 Ne Avenue A, Idabel, OK, 74740-9515
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1831304922
Provider Name
Terry Eugene Wallace
Credential
CADC
Provider Entity Type
Individual
Gender
Male
Address
104 Ne Avenue A, Idabel, OK, 74740-9515
Phone Number
580-286-3301
Fax Number
Provider Enumeration Date
05/11/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
104 Ne Avenue A
City
Idabel
State
Oklahoma
Zip
74745
Phone Number
580-286-3301
Fax Number
person
Provider Business Mailing Address Details
Address
104 Ne Avenue A
City
Idabel
State
Oklahoma
Zip
74745
Phone Number
580-286-3301
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
71 (Oklahoma)
Definition
Definition to come...
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