Provider Demographics
NPI:1760594188
Name:WADE, JOHN WILLIAM JR (MDIV LPC LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WILLIAM
Last Name:WADE
Suffix:JR
Gender:M
Credentials:MDIV LPC LMFT
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Mailing Address - Street 1:3400 BISSONNET ST
Mailing Address - Street 2:STE 267
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2155
Mailing Address - Country:US
Mailing Address - Phone:713-529-4588
Mailing Address - Fax:713-529-4589
Practice Address - Street 1:3400 BISSONNET ST
Practice Address - Street 2:STE 267
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2155
Practice Address - Country:US
Practice Address - Phone:713-529-4588
Practice Address - Fax:713-529-4589
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX1534101YP2500X
TX432106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist