MEDICARE: ELIZABETH SORRELL WADE 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	18686	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83882L	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942343603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH SORRELL WADE LPC

Provider Business Mailing Address
First Line	:	PO BOX 131
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-0131
Country	:	US
Telephone Number	:	903-253-1705
Fax Number	:	903-586-0929

Provider Business Practice Location Address
First Line	:	514 E COMMERCE ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-4910
Country	:	US
Telephone Number	:	903-253-1705
Fax Number	:	903-586-0929

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	10/23/2024

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