Provider Demographics
NPI:1427799618
Name:CORLEY, AMBER DANIELLE
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:DANIELLE
Last Name:CORLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:DANIELLE
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4419 WESTCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8648
Mailing Address - Country:US
Mailing Address - Phone:678-480-6728
Mailing Address - Fax:
Practice Address - Street 1:4419 WESTCLIFFE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8648
Practice Address - Country:US
Practice Address - Phone:678-480-6728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional