Provider Demographics
NPI:1790980688
Name:WYRE, CHARLES H (LMFT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:H
Last Name:WYRE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 WOODWARD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4172
Mailing Address - Country:US
Mailing Address - Phone:407-896-7221
Mailing Address - Fax:407-896-9670
Practice Address - Street 1:1615 WOODWARD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4172
Practice Address - Country:US
Practice Address - Phone:407-896-7221
Practice Address - Fax:407-896-9670
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT0000133106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT0000133OtherMARRIAGE FAMILY THERAPIST