Provider Demographics
NPI:1962112508
Name:AMANECER MIND MEDICINE PLLC
Entity type:Organization
Organization Name:AMANECER MIND MEDICINE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-330-6865
Mailing Address - Street 1:167 NE KAMIAKEN ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2611
Mailing Address - Country:US
Mailing Address - Phone:509-715-1400
Mailing Address - Fax:
Practice Address - Street 1:167 NE KAMIAKEN ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2611
Practice Address - Country:US
Practice Address - Phone:509-330-6865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)