Provider Demographics
NPI:1306389994
Name:CORDELL, WADE MALONE JR (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:MALONE
Last Name:CORDELL
Suffix:JR
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3289 E ARIS DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4235
Mailing Address - Country:US
Mailing Address - Phone:480-751-9288
Mailing Address - Fax:
Practice Address - Street 1:3289 E ARIS DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4235
Practice Address - Country:US
Practice Address - Phone:480-751-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LPC20157101YM0800X
AZLAC-15769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health