OPTIMAL VITALITY NPI 1457131328

NPI Information

NPI: 1457131328
Provider Name: OPTIMAL VITALITY
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
200 S FRONTAGE RD STE 324
BURR RIDGE, IL
ZIP 60527
Phone: (630) 360-1173
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OPTIMAL VITALITY is a mental health (including community mental health center) clinic center in Burr Ridge, IL. OPTIMAL VITALITY NPI is 1457131328. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

200 S FRONTAGE RD STE 324
BURR RIDGE, IL
ZIP 60527-953
Phone: (630) 360-1173
Fax: (331) 992-2358

The provider's authorized official is Brandi Kristen Boan .
The authorized official title is Owner and has the following contact phone number (630) 649-2819.

The enumeration date for this NPI number is 9/29/2023 and was last updated on 9/29/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101YP2500X	Counselor	Professional	No
2	103TC0700X	Psychologist	Clinical	No
3	2084P0005X	Psychiatry & Neurology	Neurodevelopmental Disabilities	No
4	103TP0016X	Psychologist	Prescribing (Medical)	No
5	133N00000X	Nutritionist		No
6	261QH0100X	Clinic/Center	Health Service	No
7	261QM0850X	Clinic/Center	Adult Mental Health	No
8	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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