Provider Demographics
NPI:1215074950
Name:WADE-ZELLER, RAQUEL D (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:D
Last Name:WADE-ZELLER
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 151
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1519
Mailing Address - Country:US
Mailing Address - Phone:713-457-4372
Mailing Address - Fax:713-457-0945
Practice Address - Street 1:9100 SOUTHWEST FWY
Practice Address - Street 2:SUITE 151
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1519
Practice Address - Country:US
Practice Address - Phone:713-457-4372
Practice Address - Fax:713-457-0945
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16550101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173161402Medicaid