Provider Demographics
NPI:1235462581
Name:WADE, ELIZABETH (LMHC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 AIRPORT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8231
Mailing Address - Country:US
Mailing Address - Phone:515-292-3023
Mailing Address - Fax:515-292-3053
Practice Address - Street 1:1525 AIRPORT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8231
Practice Address - Country:US
Practice Address - Phone:515-292-3023
Practice Address - Fax:515-292-3053
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health