Healthcare Provider Details

I. General information

NPI: 1447018973
Provider Name (Legal Business Name): VISTAMIND HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S WASHINGTON ST STE 288
NAPERVILLE IL
60540-6781
US

IV. Provider business mailing address

489 W DORSET AVE
PALATINE IL
60067-6070
US

V. Phone/Fax

Practice location:
  • Phone: 630-965-3632
  • Fax: 534-429-4312
Mailing address:
  • Phone: 630-965-3632
  • Fax: 534-429-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. CYRIAQUE GEORGINI TETCHI
Title or Position: MANAGER
Credential: APRN-FPA
Phone: 630-965-3632