Provider Demographics
NPI:1831686161
Name:WADE, ANDREW A (PSYD, LBA, BCBA)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:A
Last Name:WADE
Suffix:
Gender:M
Credentials:PSYD, LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12320 N PASEO PENUELA
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4704
Mailing Address - Country:US
Mailing Address - Phone:520-834-5561
Mailing Address - Fax:
Practice Address - Street 1:2800 N HIGHWAY 87
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128-9460
Practice Address - Country:US
Practice Address - Phone:520-723-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-326103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBA-326OtherBOARD OF PSYCHOLOGIST EXAMINERS
1-17-27845OtherBEHAVIOR ANALYST CERTIFICATION BOARD (BACB)