1467220772 NPI number — ACM MENTAL HEALTH AND WELLNESS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467220772 NPI number — ACM MENTAL HEALTH AND WELLNESS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACM MENTAL HEALTH AND WELLNESS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467220772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1407 OAKLAND BLVD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94596-8406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-357-7617
Provider Business Mailing Address Fax Number:
925-357-9490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1407 OAKLAND BLVD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94596-8406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-357-7617
Provider Business Practice Location Address Fax Number:
925-357-9490
Provider Enumeration Date:
12/15/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
ARDIS
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
719-357-7617

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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