Amanda Chagolla, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4704316495 Issued in MI

Practice address

21415 Goddard Rd
Taylor, MI 48180-4247

Phone

(734) 375-6900

Fax

(734) 398-3737

NPI assigned

Aug 24, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH, MI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Modern Psych and Wellness PLLC

  • Psychologist
  • Taylor, MI
  • NPI 1104674621
  Medicare reassignment NPD
• Harbor

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Toledo, OH
  • NPI 1366526782
  Medicare reassignment NPD
• Back on Track Medical Equipment LLC

  • Prosthetic/Orthotic Supplier
  • Taylor, MI
  • NPI 1265113310
  NPD
• Harbor

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Toledo, OH
  • NPI 1932510385
  NPD (past)
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1184237885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21415 GODDARD RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481804247",
            "telephone_number": "734-375-6900",
            "fax_number": "734-398-3737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21415 GODDARD RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481804247",
            "telephone_number": "734-375-6900",
            "fax_number": "734-398-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAGOLLA",
        "first_name": "AMANDA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-24",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.0027419",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704316495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Centria
• Centria Healthcare
• Christina Cervantes
• CH MH Services (Mi), LLC
• Song Hai Nam Chae, MD
• Malena Michelle Chambers
• Sami M Chami
• Hon Chan, DO
• Michelle Chan, CCC-SLP
• Jacquetta K. Chapman, B.S.W.

• Psychiatric/Mental Health Nurse Practitioner in Taylor, MI
• Providers in Taylor, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.