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NPI Code Detail

MEDICARE: AMOS BANHAM

MEDICARE: AMOS BANHAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist
2101YA0400XAddiction (Substance Use Disorder) CounselorAK

General Provider Information

NPI Number : 1033877873
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMOS BANHAM
Provider Business Mailing Address
First Line : PO BOX 876741
Second Line :
City : WASILLA
State : AK
Zip : 99687-6741
Country : US
Telephone Number : 907-373-4732
Fax Number : 907-746-4749
Provider Business Practice Location Address
First Line : 950 S SNODGRASS DR
Second Line :
City : PALMER
State : AK
Zip : 99645-9750
Country : US
Telephone Number : 907-373-4732
Fax Number : 907-746-4749
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2021
Last Update Date : 08/16/2024

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Directions to “ AMOS BANHAM ” Practice Location

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