Individual
AMETHYST R DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1118 W AZTEC BLVD, AZTEC, NM 87410-1818
(505) 334-9474
(505) 334-9861
Mailing address
1118 W AZTEC BLVD, AZTEC, NM 87410-1818
(505) 334-9474
(505) 334-9861
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
SWB-2026-0065
NM
Other
Enumeration date
02/11/2026
Last updated
02/11/2026
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