Provider Demographics
NPI:1093425811
Name:PRYKHODKO, AMBERLY (LCSW)
Entity Type:Individual
Prefix:
First Name:AMBERLY
Middle Name:
Last Name:PRYKHODKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 N FM 1626 STE 305
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-3861
Mailing Address - Country:US
Mailing Address - Phone:903-371-2793
Mailing Address - Fax:
Practice Address - Street 1:589 N FM 1626 STE 305
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-3861
Practice Address - Country:US
Practice Address - Phone:903-371-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX643321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical