Provider Demographics
NPI:1700346541
Name:AMC MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:AMC MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOA
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-647-8262
Mailing Address - Street 1:1244 N. MARINE CORPS DR.
Mailing Address - Street 2:
Mailing Address - City:UPPER TUMON
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-647-8262
Mailing Address - Fax:671-647-5252
Practice Address - Street 1:263 VIETNAM VETERANS HIGHWAY
Practice Address - Street 2:
Practice Address - City:MANGILAO
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-647-8262
Practice Address - Fax:671-647-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty