Provider Demographics
NPI:1336867605
Name:WADE, MARTHA (LMFT-A)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 KINGWOOD DR STE 102F
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3174
Mailing Address - Country:US
Mailing Address - Phone:832-591-0092
Mailing Address - Fax:
Practice Address - Street 1:1110 KINGWOOD DR STE 102F
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3174
Practice Address - Country:US
Practice Address - Phone:832-591-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204709106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty