Provider Demographics
NPI:1164531331
Name:MILLS, AMY SHANTELE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SHANTELE
Last Name:MILLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:SHANTELE
Other - Last Name:BEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:207 S VAL VERDE CIR
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059-1933
Mailing Address - Country:US
Mailing Address - Phone:682-615-2080
Mailing Address - Fax:
Practice Address - Street 1:207 S VAL VERDE CIR
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:TX
Practice Address - Zip Code:76059-1933
Practice Address - Country:US
Practice Address - Phone:682-615-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10035168OtherAMERIGROUP
TX175434301Medicaid