Provider Demographics
NPI:1720556186
Name:WADE COUNSELING OF FRISCO, PLLC
Entity Type:Organization
Organization Name:WADE COUNSELING OF FRISCO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:K. OSIRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-446-8696
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214027901Medicaid