Wade Christian Peterson, MA, LPC, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

80077 Issued in TX

Practice address

4144 N Central Expy Ste 850
Dallas, TX 75204-3226

Phone

(972) 865-8782

NPI assigned

Dec 4, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

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

• Intrinsic Counseling and Treatment Center, PLLC

  • Professional Counselor
  • Fort Worth, TX
  • NPI 1013643857
  Medicare reassignment NPD Authorized official
• Dallas Therapeutic Services PLLC

  • Psychologist
  • Irving, TX
  • NPI 1932674132
  NPD (past)

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

{
    "created_epoch": "1575417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658620800000",
    "number": "1447897806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16516 PORTERFIELD LANE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4144 N CENTRAL EXPY STE 850",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752043226",
            "telephone_number": "972-865-8782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "WADE",
        "middle_name": "CHRISTIAN",
        "name_prefix": "Mr.",
        "credential": "MA, LPC, NCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-12-04",
        "last_updated": "2022-07-24",
        "certification_date": "2022-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "80077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Peterson
• Ric Donald Peterson, OD
• Samirah H Peterson
• Sarah Rosary Peterson, CCC-SLP
• Stefan Peterson, MD
• William S. Peterson, M.D.
• Jacqueline Shirley Petescia, AUD
• Brandon Petite
• Lauren Petka
• Radina G. Petkova, DDS

• Mental Health Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.