Provider Demographics
NPI:1942982079
Name:ADAIR, AMY MICHELLE (LMHC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:ADAIR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 28164
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-8164
Mailing Address - Country:US
Mailing Address - Phone:323-770-1715
Mailing Address - Fax:
Practice Address - Street 1:920 SALAZAR RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-8224
Practice Address - Country:US
Practice Address - Phone:575-751-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health