| Vitalmind Response LLC | |
|
143 Boardman-canfield Road, Pmb #339 Boardman OH 44512 | |
| (330) 274-4803 | |
| Not Available |
| Full Name | Vitalmind Response LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 143 Boardman-canfield Road, Pmb #339, Boardman, Ohio |
| Authorized Official Name and Position | Quayla Simms (OWNER) |
| Authorized Official Contact | 3305182156 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitalmind Response LLC 2864 Bears Den Ct Youngstown OH 44511-1214 | Vitalmind Response LLC 143 Boardman-canfield Road, Pmb #339 Boardman OH 44512 Ph: (330) 274-4803 |
| NPI Number | 1942161872 |
|---|---|
| Provider Enumeration Date | 11/20/2025 |
| Last Update Date | 07/27/2026 |
| Certification Date | 07/27/2026 |
| Medicare PECOS PAC ID | 7416422084 |
|---|---|
| Medicare Enrollment ID | O20260519001850 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942161872 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (NU) | Primary |
| Provider Name | Quayla Simms |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366902959 PECOS PAC ID: 3779016498 Enrollment ID: I20241101001245 |
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