Provider Demographics
NPI:1356496061
Name:WILLIAMS, AMY (LPCC, CCFC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPCC, CCFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1293
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-1293
Mailing Address - Country:US
Mailing Address - Phone:575-770-9581
Mailing Address - Fax:
Practice Address - Street 1:1219 GUSDORF RD STE E
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6499
Practice Address - Country:US
Practice Address - Phone:575-770-9581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
F18506101YA0400X
NM005527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10859519Medicaid