Healthcare Provider Details

I. General information

NPI: 1275132771
Provider Name (Legal Business Name): AMBER WILSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 MAYFIELD RD # 1002
MAYFIELD HEIGHTS OH
44124-2905
US

IV. Provider business mailing address

5950 MAYFIELD RD # 1002
MAYFIELD HEIGHTS OH
44124-2905
US

V. Phone/Fax

Practice location:
  • Phone: 314-301-9922
  • Fax:
Mailing address:
  • Phone: 314-301-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2020009171
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: