Amygdala Co

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

AMYGDALA CO

Practice address

110 N High St Ste 3
Belleville, IL 62220-1436

Phone

(314) 518-7967

NPI assigned

Feb 8, 2022

Last updated

Feb 8, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lindsey J WoldNPI 1508328352

Title

Ceo

Phone

(314) 518-7967

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Tax ID family

Amygdala Co2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Amygdala Co

  • Adolescent and Children Mental Health Clinic/Center
  • Belleville, IL
  • NPI 1477171528
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lindsey J Wold, MA

  • Mental Health Counselor
  • Bangor, ME
  • NPI 1508328352
  NPD Authorized official

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

{
    "created_epoch": "1644278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644278400000",
    "number": "1841944980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 N HIGH ST STE 3",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201436",
            "telephone_number": "314-518-7967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N HIGH ST STE 3",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201436",
            "telephone_number": "314-518-7967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMYGDALA CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-08",
        "last_updated": "2022-02-08",
        "certification_date": "2022-01-27",
        "status": "A",
        "authorized_official_last_name": "WOLD",
        "authorized_official_first_name": "LINDSEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-518-7967"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER NPI",
            "identifier": "1477171528",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@amygdalaco.com",
            "affiliation": "N",
            "address_1": "110 N High St Ste 3",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622201436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Adolescent and Children Mental Health Clinic/Center in Belleville, IL
• Providers in Belleville, IL by specialty
• Adolescent and Children Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; 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.