Provider Demographics
NPI:1316971997
Name:HARRIS, AMBER (LCMFT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:HARRIS-WUNDERLICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCMFT
Mailing Address - Street 1:1033 N BUCKNER ST
Mailing Address - Street 2:206
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1824
Mailing Address - Country:US
Mailing Address - Phone:316-789-8511
Mailing Address - Fax:316-789-8511
Practice Address - Street 1:1033 N BUCKNER ST
Practice Address - Street 2:206
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1824
Practice Address - Country:US
Practice Address - Phone:316-789-8511
Practice Address - Fax:316-789-8511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200429340DMedicaid