Healthcare Provider Details

I. General information

NPI: 1932047503
Provider Name (Legal Business Name): UNTANGLING MINDS PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 W ILES AVE STE A
SPRINGFIELD IL
62704-7001
US

IV. Provider business mailing address

1207 N MILTON AVE
SPRINGFIELD IL
62702-4433
US

V. Phone/Fax

Practice location:
  • Phone: 217-380-1655
  • Fax:
Mailing address:
  • Phone: 217-380-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY JOHNSON-BEY
Title or Position: OWNER
Credential: PMHNP
Phone: 217-553-1915