Healthcare Provider Details

I. General information

NPI: 1285429126
Provider Name (Legal Business Name): AMY MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E REYNOLDS DR STE E3
RUSTON LA
71270-2873
US

IV. Provider business mailing address

206 E REYNOLDS DR STE E3
RUSTON LA
71270-2873
US

V. Phone/Fax

Practice location:
  • Phone: 318-598-9652
  • Fax:
Mailing address:
  • Phone: 318-598-9652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC11339
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: