Individual
AMBER N WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, LAC
Contact information
Practice address
325 N GIBSON RD APT 815, HENDERSON, NV 89014-6734
(620) 804-2942
Mailing address
325 N GIBSON RD APT 815, HENDERSON, NV 89014-6734
(620) 804-2942
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
LAC-1266
KS
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
KS
101YM0800X
Mental Health Counselor
3114
KS
101YP2500X
Professional Counselor
3172
KS
101YP2500X
Professional Counselor
Primary
CP3252-R
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201167420A
—
KS
05
—
250012412
—
NV
Enumeration date
02/29/2012
Last updated
10/03/2022
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