Healthcare Provider Details

I. General information

NPI: 1912590209
Provider Name (Legal Business Name): AMEN CLINICS INC, DALLAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 STATE HIGHWAY 161 STE 170
IRVING TX
75039-2812
US

IV. Provider business mailing address

7301 STATE HIGHWAY 161 STE 170
IRVING TX
75039-2812
US

V. Phone/Fax

Practice location:
  • Phone: 214-483-7070
  • Fax:
Mailing address:
  • Phone: 214-483-7070
  • Fax:

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: MS
Phone: 703-880-4000