MEDICARE: OMNI PSYCHIATRY LLC

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	:	1831024736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNI PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	10522 PLEASANT VALLEY RD
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-9332
Country	:	US
Telephone Number	:	419-560-8126
Fax Number	:

Provider Business Practice Location Address
First Line	:	10522 PLEASANT VALLEY RD
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-9332
Country	:	US
Telephone Number	:	419-560-8126
Fax Number	:

Authorized Official
Title or Position	:	PMHNP
Name	:	TORY TOBIN
Credential	:	PMHNP-BC
Telephone Number	:	419-560-8126

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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