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General NPI Number Information
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NPI Number | 1144927286
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Entity Type | Individual
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Provider Name | MACY WADE
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Gender | Female
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Dates
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Enumeration Date | 02/09/2023
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 689 S HIGHWAY 69
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City | PITTSBURG
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State | KS
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Zip | 66762-8600
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Country | US
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Telephone | 620-412-7475
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Fax |
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Provider Business Mailing Address
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Address Line | 549 E 600TH AVE
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City | PITTSBURG
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State | KS
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Zip | 66762-8516
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Country | US
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Telephone | 620-583-0114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 03183-T
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License Number State | KS
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