Organization
AFRICAN AMERICAN MENS HEALTH CLINIC
Active
Organization
AFRICAN AMERICAN MENS HEALTH CLINIC
Active
Other names
Black Men's Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY WALLACE JR. (CO-FOUNDER & BOARD PRESIDENT)
(682) 800-3163
Entity
Organization
Contact information
Practice address
6633 E HIGHWAY 290 STE 100, AUSTIN, TX 78723-1157
(682) 800-3163
Mailing address
6633 E HIGHWAY 290 STE 100, AUSTIN, TX 78723-1157
(682) 800-3163
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
133V00000X
Registered Dietitian
—
—
152W00000X
Optometrist
—
—
202D00000X
Integrative Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Enumeration date
11/30/2023
Last updated
11/30/2023
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