Desiree Wade, LPC
Individual provider Active NPI Professional Counselor · Saint Anthony, ID
NPI 1871962845 · NPPES record last updated Jun 4, 2024
Key facts
- NPI
- 1871962845
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC-5893 (ID)
- Practice address
- 316 N Pine St
Saint Anthony, ID 83445-5353 - Phone
- (208) 313-0926
- NPI assigned
- Sep 21, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-5893 | ID | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-5893 | ID | Yes |
Addresses
Primary practice location
316 N Pine St
Saint Anthony, ID 83445-5353
Mailing address
316 N Pine St
Saint Anthony, ID 83445-5353
Phone (208) 313-0926
Other practice location 1
1970 E 17th St Ste 204
Idaho Falls, ID 83404-8048
Phone (208) 356-0088
Other practice location 2
2590 S 2000 W Ste 2
Rexburg, ID 83440-4028
Phone (208) 356-0088
Other providers in Saint Anthony, ID
- John R.F. Toenjes
- Upper Valley Community Health Services Inc
- Upper Valley Community Health Services Inc
- Upper Valley Community Health Services Inc
- Upper Valley Community Health Services Inc
- Shauna A Wasden
- Spencer Emery Webb
- West Jefferson Family Health
- Trevor Glade Wilde
- Jenny Rickell Willmore
All providers in Saint Anthony, ID · Professional Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.