Provider Demographics
NPI:1225297690
Name:VISTA BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:VISTA BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASANTE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MENDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-269-3101
Mailing Address - Street 1:152 SIMSBURY RD
Mailing Address - Street 2:BUILDING 9 2ND FLOOR
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3777
Mailing Address - Country:US
Mailing Address - Phone:860-269-3101
Mailing Address - Fax:
Practice Address - Street 1:152 SIMSBURY RD
Practice Address - Street 2:BUILDING 9 2ND FLOOR
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3777
Practice Address - Country:US
Practice Address - Phone:860-269-3101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0460422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT98023052Medicare PIN