Provider Demographics
NPI:1093489593
Name:WADE, NATASHA C (MSW, NLC)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:C
Last Name:WADE
Suffix:
Gender:F
Credentials:MSW, NLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 E 97TH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2461
Mailing Address - Country:US
Mailing Address - Phone:720-252-0333
Mailing Address - Fax:
Practice Address - Street 1:2130 E 97TH PL
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2461
Practice Address - Country:US
Practice Address - Phone:720-252-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0108397102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0108397OtherNLC NUMBER