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General NPI Number Information
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NPI Number | 1629870506
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Entity Type | Organization
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Legal Business Name | VICTORY MENTAL SERVICES LLC
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 7060 CENTENNIAL DR STE 102C
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City | TINLEY PARK
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State | IL
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Zip | 60477-1699
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Country | US
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Telephone | 708-575-8043
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Fax | 708-575-7872
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Provider Business Mailing Address
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Address Line | 7060 CENTENNIAL DR STE 102C
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City | TINLEY PARK
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State | IL
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Zip | 60477-1699
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Country | US
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Telephone | 708-575-8043
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Fax | 708-575-7872
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Authorized Official
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Title or Position | PMHNP
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Name | IDAYATU OLA OMONIYI
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Credential | APRN PMHNP
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Telephone | 708-575-8043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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