Provider Demographics
NPI:1811327976
Name:WADE, CHASE (LPC)
Entity type:Individual
Prefix:MR
First Name:CHASE
Middle Name:
Last Name:WADE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 WALKER BLVD
Mailing Address - Street 2:L133
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-5693
Mailing Address - Country:US
Mailing Address - Phone:817-706-5551
Mailing Address - Fax:
Practice Address - Street 1:6041 WALKER BLVD
Practice Address - Street 2:L133
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180
Practice Address - Country:US
Practice Address - Phone:817-706-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional