Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 37583 | TX |
NPI | 1104350297 |
---|---|
Provider Name | Allyson Wade |
First Address | Dallas, TX 75243-1886 |
Second Address | Dallas, TX 75243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2017 |
Last Update Date | 18/05/2019 |