Wade Petree, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

38351 Issued in TX

Practice address

921 Proton Rd
San Antonio, TX 78258-4203

Phone

(210) 551-1408

NPI assigned

Dec 16, 2019

Last updated

Dec 7, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: aeonpsych.wadepetree@150802.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aeon Psychological Services PLLC

  • Psychologist
  • San Antonio, TX
  • NPI 1548873227
  NPD Authorized official

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

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1336787753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 PROTON RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584203",
            "telephone_number": "210-551-1408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 PROTON RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584203",
            "telephone_number": "210-551-1408"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "510 Med Ct Ste 106",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782583483",
            "country_code": "US",
            "telephone_number": "210-495-0675",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETREE",
        "first_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-12-16",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "38351",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "38351",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Daniel Petley, DO
• Leila Petok
• F Charles Petr Jr., MD
• Petra Health, Inc. (Total Home Health)
• Carson Cope Petrash, MD
• Matei Stefan Petrescu, MD
• Francesca Petrey, DPT,OCS
• Pamela Petri, LCSW
• Roberta Petric
• Jasmine Petrick

• Psychologist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.