Provider Demographics
NPI:1326385790
Name:AMYGDALA CLINIC INC
Entity Type:Organization
Organization Name:AMYGDALA CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLAJIDE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MASHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-772-1111
Mailing Address - Street 1:8875 W BELLFORT ST STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-2566
Mailing Address - Country:US
Mailing Address - Phone:713-772-1111
Mailing Address - Fax:
Practice Address - Street 1:8875 W BELLFORT ST STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-2566
Practice Address - Country:US
Practice Address - Phone:713-772-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-05
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7406103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty