Provider Demographics
NPI:1710661723
Name:WADE, ALEXIS (LPC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-5820
Mailing Address - Country:US
Mailing Address - Phone:903-327-6142
Mailing Address - Fax:
Practice Address - Street 1:1303 LAFAYETTE DR
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-5820
Practice Address - Country:US
Practice Address - Phone:903-327-6142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85460101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional