1174594048 NPI number — DR. WESLEY M. EADES PH.D., LPC, LMFT

Table of content: DR. WESLEY M. EADES PH.D., LPC, LMFT (NPI 1174594048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174594048 NPI number — DR. WESLEY M. EADES PH.D., LPC, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EADES
Provider First Name:
WESLEY
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., LPC, LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EADES
Provider Other First Name:
WESLEY
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1174594048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2421
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76703-2421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-498-7176
Provider Business Mailing Address Fax Number:
254-230-4401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 AUSTIN AVE
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76701-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-498-7176
Provider Business Practice Location Address Fax Number:
254-230-4401
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  11800 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 3445 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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