Active NPI
Jody Mae Mangold, RSA
- Mental Health Counselor
- Beardstown, IL
National Provider Identifier
1730668286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 121 E 2ND St
Beardstown, IL 62618-1263 - Phone
- (217) 323-2980
- Fax
- (217) 323-3731
- NPI assigned
- Aug 7, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
121 E 2ND St
Beardstown, IL 62618-1263
Mailing address
121 E 2ND St
Beardstown, IL 62618-1263
Phone (217) 323-2980
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583798400000",
"number": "1730668286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 E 2ND ST",
"city": "BEARDSTOWN",
"state": "IL",
"postal_code": "626181263",
"telephone_number": "217-323-2980",
"fax_number": "217-323-3731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 E 2ND ST",
"city": "BEARDSTOWN",
"state": "IL",
"postal_code": "626181263",
"telephone_number": "217-323-2980",
"fax_number": "217-323-3731"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGOLD",
"first_name": "JODY",
"middle_name": "MAE",
"credential": "RSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-07",
"last_updated": "2020-03-10",
"certification_date": "2020-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beardstown, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.