Healthcare Provider Details

I. General information

NPI: 1699541250
Provider Name (Legal Business Name): MARLENE WADLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5114 PARK RD
LAVACA AR
72941-6085
US

IV. Provider business mailing address

839 W CONGRESS ST
TUCSON AZ
85745-2819
US

V. Phone/Fax

Practice location:
  • Phone: 661-210-6924
  • Fax:
Mailing address:
  • Phone: 520-670-3909
  • Fax: 520-309-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2503016
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC24698
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13016
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: