MEDICARE: MRS. AMY SHANTELE MILLS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	19670	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10035168	OTHER	TX	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164531331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY SHANTELE MILLS LPC

Provider Business Mailing Address
First Line	:	207 S VAL VERDE CIR
Second Line	:
City	:	KEENE
State	:	TX
Zip	:	76059-1933
Country	:	US
Telephone Number	:	682-615-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 S VAL VERDE CIR
Second Line	:
City	:	KEENE
State	:	TX
Zip	:	76059-1933
Country	:	US
Telephone Number	:	682-615-2080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/17/2018

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