Healthcare Provider Details

I. General information

NPI: 1528374154
Provider Name (Legal Business Name): AMANDA OCTAVIA NICHOLE HARDY-MILLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 02/14/2023
Certification Date: 01/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 FT RICHARDSON AVE
GOODFELLOW TX
76908
US

IV. Provider business mailing address

271 FT RICHARDSON AVE
GOODFELLOW AIR FORCE BASE TX
76908
US

V. Phone/Fax

Practice location:
  • Phone: 325-654-3122
  • Fax: 325-654-5161
Mailing address:
  • Phone: 325-654-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY.0003909
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: