Provider Demographics
NPI:1932465952
Name:WADE, DEBORAH M (MA, LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:M
Last Name:WADE
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TEXAN TRL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3776
Mailing Address - Country:US
Mailing Address - Phone:817-328-0888
Mailing Address - Fax:817-310-0746
Practice Address - Street 1:1000 TEXAN TRL
Practice Address - Street 2:SUITE 205
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3776
Practice Address - Country:US
Practice Address - Phone:817-328-0888
Practice Address - Fax:817-310-0746
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2179106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist