MEDICARE: DR. WESLEY M. EADES PH.D., LPC, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	11800	TX
2	106H00000X	Marriage & Family Therapist	3445	TX

General Provider Information

NPI Number	:	1174594048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WESLEY M. EADES PH.D., LPC, LMFT

Provider Business Mailing Address
First Line	:	PO BOX 2421
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76703-2421
Country	:	US
Telephone Number	:	254-498-7176
Fax Number	:	254-230-4401

Provider Business Practice Location Address
First Line	:	900 AUSTIN AVE
Second Line	:	SUITE 501
City	:	WACO
State	:	TX
Zip	:	76701-1902
Country	:	US
Telephone Number	:	254-498-7176
Fax Number	:	254-230-4401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	10/27/2011

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