Provider Demographics
NPI:1841897725
Name:DENES, WADE JUSTIN (LMFT)
Entity type:Individual
Prefix:MR
First Name:WADE
Middle Name:JUSTIN
Last Name:DENES
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5443 GOOSEBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-4638
Mailing Address - Country:US
Mailing Address - Phone:818-212-5881
Mailing Address - Fax:
Practice Address - Street 1:1302 S EL CAMINO REAL # A-3
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4290
Practice Address - Country:US
Practice Address - Phone:760-237-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122269106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist