Amaryllis Mind, Body, & Soul Counseling

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

AMARYLLIS MIND, BODY, & SOUL COUNSELING

Practice address

4509 N Illinois St
Swansea, IL 62226-1524

Phone

(314) 669-5060

NPI assigned

Oct 20, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yvonne Licavoli, LCPCNPI 1760113005

Title

Psychotherapist

Phone

(314) 397-1428

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Yvonne Licavoli

  • Professional Counselor
  • Swansea, IL
  • NPI 1760113005
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697760000000",
    "number": "1083496285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9626 RIDGE HEIGHTS RD",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082319",
            "telephone_number": "314-397-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4509 N ILLINOIS ST",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622261524",
            "telephone_number": "314-669-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMARYLLIS MIND, BODY, & SOUL COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-20",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "LICAVOLI",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "314-397-1428",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Swansea, IL
• Providers in Swansea, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.