Provider Demographics
NPI:1528374154
Name:HARDY-MILLER, AMANDA OCTAVIA NICHOLE (PHD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:OCTAVIA NICHOLE
Last Name:HARDY-MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 FT RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:GOODFELLOW AIR FORCE BASE
Mailing Address - State:TX
Mailing Address - Zip Code:76908
Mailing Address - Country:US
Mailing Address - Phone:325-654-3122
Mailing Address - Fax:
Practice Address - Street 1:271 FT RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:GOODFELLOW
Practice Address - State:TX
Practice Address - Zip Code:76908
Practice Address - Country:US
Practice Address - Phone:325-654-3122
Practice Address - Fax:325-654-5161
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0003909103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling