| Doctor Name: | DONNA K WALLACE |
| NPI Number: | 1003016320 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 18857 |
| Business Practice Address: | 1901 S 24th Ave Edinburg, TX - 785396533 |
| Business Phone Number: | 9562897000 |
| Business Fax Number: | 9562897257 |
| Mailing Address: | 5 Boca Chica Blvd Ste 5, BROWNSVILLE |
| State: | TX |
| Postal Code: | 785207863 |
| Phone Number: | 9562897000 |
| Fax Number: | 9562897025 |
| NPI Enumeration Date: | 07/24/2007 |
| NPI Last Update Date: | 07/24/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 18857 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |