MR. Kelly Wallace is a mental health counselor in Philadelphia, PA. MR. Kelly Wallace NPI is 1427726793. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
1348 BAINBRIDGE ST
PHILADELPHIA, PA
ZIP 19147-810
Phone: (215) 563-0652
The enumeration date for this NPI number is 9/1/2021 and was last updated on 9/1/2021.