Healthcare Provider Details

I. General information

NPI: 1922792076
Provider Name (Legal Business Name): VISIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 MOUNT PLEASANT LN
BELLEVILLE IL
62223-3944
US

IV. Provider business mailing address

5801 MOUNT PLEASANT LN
BELLEVILLE IL
62223-3944
US

V. Phone/Fax

Practice location:
  • Phone: 618-489-5102
  • Fax: 618-489-5103
Mailing address:
  • Phone: 618-489-5102
  • Fax: 618-489-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVE JAQUES
Title or Position: CEO
Credential: PHD
Phone: 314-560-7063