Healthcare Provider Details

I. General information

NPI: 1003608712
Provider Name (Legal Business Name): ALLIED MASTERMINDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 N SANTA FE AVE
COMPTON CA
90221-1007
US

IV. Provider business mailing address

1703 N SANTA FE AVE
COMPTON CA
90221-1007
US

V. Phone/Fax

Practice location:
  • Phone: 323-823-1683
  • Fax:
Mailing address:
  • Phone: 323-823-1683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KENYA METOYER
Title or Position: CO-OWNER
Credential:
Phone: 424-379-6797