MEDICARE: AMAE HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1902594005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAE HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	1762 WESTWOOD BLVD STE 310
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5641
Country	:	US
Telephone Number	:	424-293-0031
Fax Number	:	888-988-1786

Provider Business Practice Location Address
First Line	:	1762 WESTWOOD BLVD STE 310
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5641
Country	:	US
Telephone Number	:	424-293-0031
Fax Number	:	888-988-1786

Authorized Official
Title or Position	:	PRESIDENT AND CHIEF MEDICAL OFFICER
Name	:	SCOTT FEARS
Credential	:	MD
Telephone Number	:	424-293-0031

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	04/26/2023

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Directions to “AMAE HEALTH SERVICES LLC ” Practice Location

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