Provider Demographics
NPI:1265179477
Name:OPTIMUM MENTAL HEALTH HEALING
Entity type:Organization
Organization Name:OPTIMUM MENTAL HEALTH HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:EICHELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:618-641-3588
Mailing Address - Street 1:1404 NOTTINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6883
Mailing Address - Country:US
Mailing Address - Phone:618-641-3588
Mailing Address - Fax:
Practice Address - Street 1:208 W POINTE DR STE B
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-8302
Practice Address - Country:US
Practice Address - Phone:618-641-3588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty