Provider Demographics
NPI:1740514553
Name:MILLARD, AMY SARA (PEER SPECIALIST)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:SARA
Last Name:MILLARD
Suffix:
Gender:F
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1578
Mailing Address - Country:US
Mailing Address - Phone:505-884-4464
Mailing Address - Fax:505-884-0093
Practice Address - Street 1:700 2ND ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1578
Practice Address - Country:US
Practice Address - Phone:505-884-4464
Practice Address - Fax:505-884-0093
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39778860Medicaid