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General NPI Number Information
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NPI Number | 1538990288
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Entity Type | Organization
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Legal Business Name | VANTAGE MENTAL HEALTH
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 5995 OREN AVE N STE 203
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City | OAK PARK HEIGHTS
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State | MN
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Zip | 55082-6379
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Country | US
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Telephone | 651-217-1480
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Fax | 833-972-5926
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Provider Business Mailing Address
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Address Line | 5995 OREN AVE N STE 203
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City | OAK PARK HEIGHTS
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State | MN
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Zip | 55082-6379
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Country | US
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Telephone | 651-217-1480
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Fax |
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Authorized Official
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Title or Position | BOARD CHAIR
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Name | JUSTIN GERSTNER
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Credential |
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Telephone | 651-217-1480
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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