Provider Demographics
NPI:1558714055
Name:BESEMER, WADE AARON (LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:AARON
Last Name:BESEMER
Suffix:
Gender:M
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CIVIC CENTER PLZ STE 1615
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7783
Mailing Address - Country:US
Mailing Address - Phone:507-345-4679
Mailing Address - Fax:
Practice Address - Street 1:12 CIVIC CENTER PLZ STE 1615
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7783
Practice Address - Country:US
Practice Address - Phone:507-345-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2449101YM0800X
MN303381101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)