MEDICARE: LAURA L. ALLEN-WADE MA, LPC

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	LPC-5259	ID

General Provider Information

NPI Number	:	1912331299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA L. ALLEN-WADE MA, LPC

Provider Business Mailing Address
First Line	:	11644 W MOUNT HOOD AVE
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83651-8708
Country	:	US
Telephone Number	:	208-409-7069
Fax Number	:

Provider Business Practice Location Address
First Line	:	7161 W POTOMAC DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-9148
Country	:	US
Telephone Number	:	208-908-6399
Fax Number	:	866-275-9883

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

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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