Provider Demographics
NPI:1083432280
Name:AMIGOS ON THE SPECTRUM
Entity type:Organization
Organization Name:AMIGOS ON THE SPECTRUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:M
Authorized Official - Last Name:AMIGO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:614-902-2611
Mailing Address - Street 1:8740 ORION PL STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-4063
Mailing Address - Country:US
Mailing Address - Phone:614-902-2611
Mailing Address - Fax:
Practice Address - Street 1:8740 ORION PL STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4063
Practice Address - Country:US
Practice Address - Phone:614-902-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty