Provider Demographics
NPI:1497997241
Name:WADE, PANSY (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:PANSY
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-0174
Mailing Address - Country:US
Mailing Address - Phone:832-416-5473
Mailing Address - Fax:281-491-1368
Practice Address - Street 1:10701 CORPORATE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4096
Practice Address - Country:US
Practice Address - Phone:832-416-5473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62880101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204156802Medicaid