Healthcare Provider Details

I. General information

NPI: 1053963603
Provider Name (Legal Business Name): AMBER NICOLE KNOPF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER NICOLE WYCOFF

II. Dates (important events)

Enumeration Date: 07/14/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 W ORANGEWOOD AVE STE 300
ORANGE CA
92868-2053
US

IV. Provider business mailing address

PO BOX 10054
FULLERTON CA
92838-6054
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-6494
  • Fax: 714-221-3764
Mailing address:
  • Phone: 714-882-1409
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: