Provider Demographics
NPI:1689947889
Name:AMIGAS MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:AMIGAS MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUFRECT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-329-9608
Mailing Address - Street 1:1419 V ST NW # 309
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-5806
Mailing Address - Country:US
Mailing Address - Phone:202-299-1169
Mailing Address - Fax:202-567-6377
Practice Address - Street 1:1419 V ST NW # 309
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5806
Practice Address - Country:US
Practice Address - Phone:202-299-1169
Practice Address - Fax:202-567-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC400312000113174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty