Healthcare Provider Details

I. General information

NPI: 1013065325
Provider Name (Legal Business Name): WADE CHRISTIAN LUECK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S POWER RD STE 112
MESA AZ
85209-6687
US

IV. Provider business mailing address

2500 S POWER RD STE 112
MESA AZ
85209-6687
US

V. Phone/Fax

Practice location:
  • Phone: 480-382-3008
  • Fax:
Mailing address:
  • Phone: 480-382-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3801
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: