Teresa Gale Rue-Wallace, BA,MS

Individual provider Active NPI Mental Health Counselor · Wynnewood, OK

NPI 1861723264 · NPPES record last updated Jan 25, 2010

Key facts

NPI
1861723264
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
Practice address
34668 E County Road 1650
Wynnewood, OK 73098-9173
Phone
(405) 306-8511
Fax
(405) 665-6396
NPI assigned
Jan 25, 2010
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Bachelor of Arts, Master of Science

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Yes

Addresses

Primary practice location

34668 E County Road 1650
Wynnewood, OK 73098-9173

Mailing address

34668 E County Road 1650
Wynnewood, OK 73098-9173
Phone (405) 306-8511

Other providers in Wynnewood, OK

All providers in Wynnewood, OK · Mental Health Counselor in Oklahoma

Sources for this page

Verify at the official NPI Registry.