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General NPI Number Information
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NPI Number | 1790980688
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Entity Type | Individual
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Provider Name | CHARLES H. WYRE LMFT
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Gender | Male
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1615 WOODWARD ST
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City | ORLANDO
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State | FL
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Zip | 32803-4172
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Country | US
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Telephone | 407-896-7221
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Fax | 407-896-9670
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Provider Business Mailing Address
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Address Line | 1615 WOODWARD ST
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City | ORLANDO
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State | FL
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Zip | 32803-4172
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Country | US
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Telephone | 407-896-7221
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Fax | 407-896-9670
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT0000133
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License Number State | FL
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