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General NPI Number Information
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NPI Number | 1225297690
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Entity Type | Organization
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Legal Business Name | VISTA BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 152 SIMSBURY RD BUILDING 9 2ND FLOOR
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City | AVON
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State | CT
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Zip | 06001-3777
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Country | US
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Telephone | 860-269-3101
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Fax |
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Provider Business Mailing Address
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Address Line | 152 SIMSBURY RD BUILDING 9 2ND FLOOR
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City | AVON
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State | CT
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Zip | 06001-3777
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Country | US
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Telephone | 860-269-3101
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ASANTE K MENDES
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Credential | M.D.
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Telephone | 860-269-3101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 046042
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License Number State | CT
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