Healthcare Provider Details

I. General information

NPI: 1669988044
Provider Name (Legal Business Name): AMEN CLINICS, INC WALNUT CREEK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N WIGET LN STE 105
WALNUT CREEK CA
94598-5960
US

IV. Provider business mailing address

350 N WIGET LN STE 105
WALNUT CREEK CA
94598-5960
US

V. Phone/Fax

Practice location:
  • Phone: 650-416-7830
  • Fax: 650-871-8874
Mailing address:
  • Phone: 650-416-7830
  • Fax: 650-871-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA T MCCORMICK
Title or Position: CORPORATE TRAINER
Credential:
Phone: 703-880-4000