Provider Demographics
NPI:1124184221
Name:DAVID C WADE PSY D PC
Entity Type:Organization
Organization Name:DAVID C WADE PSY D PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:541-436-2998
Mailing Address - Street 1:PO BOX 2289
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-2289
Mailing Address - Country:US
Mailing Address - Phone:509-493-1467
Mailing Address - Fax:
Practice Address - Street 1:1100 E MARINA WAY
Practice Address - Street 2:SUITE 221
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2305
Practice Address - Country:US
Practice Address - Phone:541-436-2998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1081103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR400707OtherVALUE OPTIONS
OR885235000OtherBCBS
OR115025OtherMANAGED HEALTH NETWORK
ORYC73001OtherPACIFIC SOURCE