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General NPI Number Information
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NPI Number | 1679116529
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Entity Type | Organization
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Legal Business Name | ALLIANCE FOR TELEPSYCHIATRY
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 8425 BALM ST
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City | WEEKI WACHEE
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State | FL
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Zip | 34607
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Country | US
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Telephone | 352-364-9401
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Fax | 352-293-4988
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Provider Business Mailing Address
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Address Line | 14860 ROSCOE BLVD
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City | PANORAMA CITY
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State | CA
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Zip | 91402
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Country | US
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Telephone | 747-998-0394
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Fax | 747-998-0383
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Authorized Official
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Title or Position | COO
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Name | MR. TIMOTHY WELKE
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Credential | M.A.
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Telephone | 747-998-0394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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