| Vista Behavioral Health, Llc | |
|
152 Simsbury Rd Building 9 2nd Floor Avon CT 06001-3777 | |
| (860) 269-3101 | |
| Not Available |
| Full Name | Vista Behavioral Health, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 152 Simsbury Rd, Avon, Connecticut |
| Authorized Official Name and Position | Asante K Mendes (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8602693101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vista Behavioral Health, Llc 152 Simsbury Rd Building 9 2nd Floor Avon CT 06001-3777 Ph: (860) 269-3101 | Vista Behavioral Health, Llc 152 Simsbury Rd Building 9 2nd Floor Avon CT 06001-3777 Ph: (860) 269-3101 |
| NPI Number | 1225297690 |
|---|---|
| Provider Enumeration Date | 06/02/2008 |
| Last Update Date | 09/26/2008 |
| Medicare PECOS PAC ID | 9537236989 |
|---|---|
| Medicare Enrollment ID | O20080926000136 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225297690 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 046042 (Connecticut) | Primary |
| Provider Name | Asante K Mendes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114109212 PECOS PAC ID: 2961584008 Enrollment ID: I20080129000474 |
| Provider Name | Verona Sonia Gordon Khouri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164957809 PECOS PAC ID: 9234406711 Enrollment ID: I20170605001940 |
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