Provider Demographics
| NPI: | 1669976452 |
|---|---|
| Name: | ENERGY HEALTH CENTER INCORPORATED |
| Entity type: | Organization |
| Organization Name: | ENERGY HEALTH CENTER INCORPORATED |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JULIE |
| Authorized Official - Middle Name: | ANNE |
| Authorized Official - Last Name: | GRIFFITH |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD, MS, CMT, BCIP |
| Authorized Official - Phone: | 415-925-1616 |
| Mailing Address - Street 1: | 5 BON AIR RD STE D-219 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LARKSPUR |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 94939-1143 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 415-925-1616 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 5 BON AIR RD STE D-219 |
| Practice Address - Street 2: | |
| Practice Address - City: | LARKSPUR |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 94939-1143 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 415-925-1616 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2018-03-19 |
| Last Update Date: | 2018-03-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2084N0402X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | Group - Multi-Specialty |
| No | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | Group - Multi-Specialty | |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
| No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QP3300X | Ambulatory Health Care Facilities | Clinic/Center | Pain | |
| No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | |
| No | 261QS1200X | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic | |
| No | 3336S0011X | Suppliers | Pharmacy | Specialty Pharmacy |
