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General NPI Number Information
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NPI Number | 1528374154
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Entity Type | Individual
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Provider Name | AMANDA OCTAVIA NICHOLE HARDY-MILLER PHD
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Gender | Female
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 271 FT RICHARDSON AVE
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City | GOODFELLOW
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State | TX
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Zip | 76908
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Country | US
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Telephone | 325-654-3122
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Fax | 325-654-5161
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Provider Business Mailing Address
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Address Line | 271 FT RICHARDSON AVE
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City | GOODFELLOW AIR FORCE BASE
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State | TX
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Zip | 76908
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Country | US
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Telephone | 325-654-3122
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY.0003909
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License Number State | CO
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