Organization
AMYGDALA CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDSEY WOLD MS (CEO)
(314) 518-7967
Entity
Organization
Contact information
Practice address
110 N HIGH ST STE 3, BELLEVILLE, IL 62220-1436
(314) 518-7967
Mailing address
110 N HIGH ST STE 3, BELLEVILLE, IL 62220-1436
(314) 518-7967
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477171528
NATIONAL PROVIDER IDENTIFIER
IL
Enumeration date
07/06/2020
Last updated
01/25/2022
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