Provider Demographics
NPI:1083304265
Name:WADE, KELSI ELIZABETH (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:ELIZABETH
Last Name:WADE
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657-2300
Mailing Address - Country:US
Mailing Address - Phone:254-644-1449
Mailing Address - Fax:
Practice Address - Street 1:304 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:MC GREGOR
Practice Address - State:TX
Practice Address - Zip Code:76657-2300
Practice Address - Country:US
Practice Address - Phone:254-644-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-21-57101103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst