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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