| Vibrant Integrative Psychiatry Pllc | |
|
6530 Sheridan Rd Ste 3 Kenosha WI 53143-5063 | |
| (224) 285-6006 | |
| Not Available |
| Full Name | Vibrant Integrative Psychiatry Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6530 Sheridan Rd Ste 3, Kenosha, Wisconsin |
| Authorized Official Name and Position | Ilya Melina Ray (OWNER) |
| Authorized Official Contact | 2242856006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vibrant Integrative Psychiatry Pllc 6530 Sheridan Rd Ste 3 Kenosha WI 53143-5063 Ph: (224) 285-6006 | Vibrant Integrative Psychiatry Pllc 6530 Sheridan Rd Ste 3 Kenosha WI 53143-5063 Ph: (224) 285-6006 |
| NPI Number | 1962116459 |
|---|---|
| Provider Enumeration Date | 01/09/2023 |
| Last Update Date | 04/10/2023 |
| Certification Date | 04/10/2023 |
| Medicare PECOS PAC ID | 7911362033 |
|---|---|
| Medicare Enrollment ID | O20230425001304 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962116459 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Ilya Ray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447639737 PECOS PAC ID: 2365758539 Enrollment ID: I20150902001801 |
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