Healthcare Provider Details

I. General information

NPI: 1902296056
Provider Name (Legal Business Name): WADE MICHAEL MCGUIRE LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 FIELDS DR STE 102
BOWLING GREEN KY
42104-5381
US

IV. Provider business mailing address

944 FIELDS DR STE 102
BOWLING GREEN KY
42104-5381
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-7029
  • Fax:
Mailing address:
  • Phone: 270-904-7029
  • Fax: 270-826-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number173956
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCCCA00216570
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: