Search › Oklahoma › 101YA0400X
Terry Wallace, CADC
NPI 1831304922 · on the registry since 2007 · sole proprietor
Practice
- Address
- 104 Ne Avenue A
Idabel, OK 74745 - Phone
- (580) 286-3301
- Organisation at this address
- Kiamichi Council On Alcohoism And Other Drug Abuse Inc.
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 6
Registry record
- Primary taxonomy
- 101YA0400X
101YA0400X
- Also registered as
- 101YA0400X
101YA0400X - Licence states on file
- OK
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2007-07-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Oklahoma