Provider Demographics
NPI:1104542596
Name:VITAL MIND PSYCHIATRY LLP
Entity type:Organization
Organization Name:VITAL MIND PSYCHIATRY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNP
Authorized Official - Prefix:MS
Authorized Official - First Name:MISTIQUE
Authorized Official - Middle Name:CHANTAY
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:614-597-2132
Mailing Address - Street 1:711 S GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2233
Mailing Address - Country:US
Mailing Address - Phone:614-597-2132
Mailing Address - Fax:
Practice Address - Street 1:6055 TAIN DR # 202
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-8560
Practice Address - Country:US
Practice Address - Phone:614-233-1825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty