Provider Demographics
NPI:1790961027
Name:WADE, KARLA MARIE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:MARIE
Last Name:WADE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 ALLUMBAUGH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9210
Mailing Address - Country:US
Mailing Address - Phone:208-338-4699
Mailing Address - Fax:208-322-4722
Practice Address - Street 1:411 ALLUMBAUGH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9210
Practice Address - Country:US
Practice Address - Phone:208-338-4699
Practice Address - Fax:208-322-4722
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3547101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor