Provider Demographics
NPI:1588858435
Name:WYRICK, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WYRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 DARBY CREEK RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1604
Mailing Address - Country:US
Mailing Address - Phone:859-314-1281
Mailing Address - Fax:
Practice Address - Street 1:5011 ATWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8898
Practice Address - Country:US
Practice Address - Phone:859-314-1281
Practice Address - Fax:859-353-8032
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1742103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling