Healthcare Provider Details

I. General information

NPI: 1700346541
Provider Name (Legal Business Name): AMC MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 VIETNAM VETERANS HIGHWAY
MANGILAO GU
96913
US

IV. Provider business mailing address

1244 N. MARINE CORPS DR.
UPPER TUMON GU
96913
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-8262
  • Fax: 671-647-5252
Mailing address:
  • Phone: 671-647-8262
  • Fax: 671-647-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: HOA VAN NGUYEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 671-647-8262