Healthcare Provider Details

I. General information

NPI: 1952872053
Provider Name (Legal Business Name): TAMARIA S WADE M.ED, CSC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2162 SPRING STUEBNER RD STE 140-1038
SPRING TX
77389-5298
US

IV. Provider business mailing address

2162 SPRING STUEBNER RD STE 140-1038
SPRING TX
77389-5298
US

V. Phone/Fax

Practice location:
  • Phone: 832-786-9045
  • Fax:
Mailing address:
  • Phone: 832-786-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number76723
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: