Healthcare Provider Details

I. General information

NPI: 1104469824
Provider Name (Legal Business Name): AMBER CHRISTINE WRYE LCDC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5433 ALPHA RD
DALLAS TX
75240
US

IV. Provider business mailing address

2816 VINE ST APT 360
DALLAS TX
75204-4036
US

V. Phone/Fax

Practice location:
  • Phone: 561-601-5436
  • Fax:
Mailing address:
  • Phone: 561-601-5436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11705
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number79721
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: