Michael Keith Wade, LPC-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

68877 Issued in TX

Practice address

2104 E Yandell Dr Ste 9
El Paso, TX 79903-3517

Phone

(915) 277-0300

NPI assigned

Nov 27, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661558400000",
    "number": "1053741173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 E YANDELL DR STE 9",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799033517",
            "telephone_number": "915-277-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 E YANDELL DR STE 9",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799033517",
            "telephone_number": "915-277-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "MICHAEL",
        "middle_name": "KEITH",
        "credential": "LPC-S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-11-27",
        "last_updated": "2022-08-27",
        "certification_date": "2022-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "68877",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "68877",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "68877",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "68877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• W.C. Larock, D.C. , P.C.
• Allen Wadja, PT
• Brianne Wagenman, PA-C
• Brook Rene Wager, M.D.
• Jacob Aaron Waggoner, PHD
• Elizabeth H. Wagner, MS, ATC,LAT

• Professional Counselor in El Paso, TX
• Providers in El Paso, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.