Basic Information
| Provider Information | |||||||||
| NPI: | 1700346541 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMC MENTAL HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1244 N. MARINE CORPS DR. | ||||||||
| Address2: | |||||||||
| City: | UPPER TUMON | ||||||||
| State: | GU | ||||||||
| PostalCode: | 96913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716478262 | ||||||||
| FaxNumber: | 6716475252 | ||||||||
| Practice Location | |||||||||
| Address1: | 263 VIETNAM VETERANS HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | MANGILAO | ||||||||
| State: | GU | ||||||||
| PostalCode: | 96913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716478262 | ||||||||
| FaxNumber: | 6716475252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2019 | ||||||||
| LastUpdateDate: | 03/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | NGUYEN | ||||||||
| AuthorizedOfficialFirstName: | HOA | ||||||||
| AuthorizedOfficialMiddleName: | VAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6716478262 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
No ID Information.