Provider Demographics
NPI:1124749411
Name:WADE, EZRA CHRISTOPHER (LPC, NCC)
Entity type:Individual
Prefix:
First Name:EZRA
Middle Name:CHRISTOPHER
Last Name:WADE
Suffix:
Gender:X
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:NEAL
Other - Last Name:WADE
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017807101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional