Provider Demographics
NPI:1821703224
Name:VIBRANT MINDS INC
Entity Type:Organization
Organization Name:VIBRANT MINDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN SERKE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:414-303-0319
Mailing Address - Street 1:1126 NOYES ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2634
Mailing Address - Country:US
Mailing Address - Phone:414-303-0319
Mailing Address - Fax:
Practice Address - Street 1:947 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1848
Practice Address - Country:US
Practice Address - Phone:414-303-0319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty