Provider Demographics
NPI:1487648366
Name:WAMPLER, PATRICIA LYNN (LMSW ACP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LYNN
Last Name:WAMPLER
Suffix:
Gender:F
Credentials:LMSW ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17115 RED OAK DR
Mailing Address - Street 2:STE 109
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2607
Mailing Address - Country:US
Mailing Address - Phone:281-893-4111
Mailing Address - Fax:281-893-8082
Practice Address - Street 1:17115 RED OAK DR
Practice Address - Street 2:STE 109
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2607
Practice Address - Country:US
Practice Address - Phone:281-893-4111
Practice Address - Fax:281-893-8082
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08368104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038325901Medicaid
R69669Medicare UPIN
TX81065PMedicare ID - Type Unspecified