Provider Demographics
NPI:1598008799
Name:AGUILLARD, AMIE
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:AGUILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LOUIS PRIMA DR STE A
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5903
Mailing Address - Country:US
Mailing Address - Phone:985-327-5427
Mailing Address - Fax:985-327-8800
Practice Address - Street 1:60 LOUIS PRIMA DR STE A
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-327-5427
Practice Address - Fax:985-327-8800
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6316101YM0800X, 101YP2500X
MS1913101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health