MEDICARE: CHIRAL MIND PSYCHIATRY A PROFESSIONAL NURSING CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1194672295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRAL MIND PSYCHIATRY A PROFESSIONAL NURSING CORPORATION

Provider Business Mailing Address
First Line	:	1063 SAN PABLO AVE STE B ROOM #3
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2473
Country	:	US
Telephone Number	:	248-979-6373
Fax Number	:

Provider Business Practice Location Address
First Line	:	1063 SAN PABLO AVE STE B ROOM # 3
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2473
Country	:	US
Telephone Number	:	248-979-6373
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAMMIE SIMS-RUSSELL
Credential	:	DNP, PMHNP-BC
Telephone Number	:	248-979-6373

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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