# AMY M WILDE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1841708963
- **Gender:** F
- **Credential:** ACMHC, LSUDC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 302808-6006 | UT | — |
| 101YM0800X | Mental Health Counselor | 302808-6009 | UT | Yes |

## Other

- **Enumeration date:** 01/11/2018
- **Last updated:** 01/11/2018