Provider Demographics
NPI:1508181322
Name:WADE, K OSIRIS (LPC-S, NCC)
Entity Type:Individual
Prefix:
First Name:K OSIRIS
Middle Name:
Last Name:WADE
Suffix:
Gender:M
Credentials:LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 MAIN ST STE 243
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4477
Mailing Address - Country:US
Mailing Address - Phone:720-446-8696
Mailing Address - Fax:972-704-3629
Practice Address - Street 1:2770 MAIN ST STE 243
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4477
Practice Address - Country:US
Practice Address - Phone:720-446-8696
Practice Address - Fax:972-704-3629
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63200101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional