Provider Demographics
NPI:1245997394
Name:WAKEMAN, AMBER (LMHC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WAKEMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E BAY ST STE 8
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-4983
Mailing Address - Country:US
Mailing Address - Phone:863-777-9184
Mailing Address - Fax:
Practice Address - Street 1:215 E BAY ST STE 8
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4983
Practice Address - Country:US
Practice Address - Phone:863-777-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health