Provider Demographics
NPI:1174594048
Name:EADES, WESLEY M (PHD, LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:M
Last Name:EADES
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:DR
Other - First Name:WESLEY
Other - Middle Name:M
Other - Last Name:EADES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 2421
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76703-2421
Mailing Address - Country:US
Mailing Address - Phone:254-498-7176
Mailing Address - Fax:254-230-4401
Practice Address - Street 1:900 AUSTIN AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1902
Practice Address - Country:US
Practice Address - Phone:254-498-7176
Practice Address - Fax:254-230-4401
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11800101YM0800X
TX3445106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist