MEDICARE: MR. JOHN WILLIAM WADE JR. MDIV 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	101YP2500X	Professional Counselor	1534	TX
2	106H00000X	Marriage & Family Therapist	432	TX

General Provider Information

NPI Number	:	1760594188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN WILLIAM WADE JR. MDIV LPC LMFT

Provider Business Mailing Address
First Line	:	3400 BISSONNET ST
Second Line	:	STE 267
City	:	HOUSTON
State	:	TX
Zip	:	77005-2155
Country	:	US
Telephone Number	:	713-529-4588
Fax Number	:	713-529-4589

Provider Business Practice Location Address
First Line	:	3400 BISSONNET ST
Second Line	:	STE 267
City	:	HOUSTON
State	:	TX
Zip	:	77005-2155
Country	:	US
Telephone Number	:	713-529-4588
Fax Number	:	713-529-4589

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/11/2025

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