Organization
VIBRANT INTEGRATIVE PSYCHIATRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILYA MELINA RAY APNP (OWNER)
(224) 285-6006
Entity
Organization
Contact information
Practice address
6530 SHERIDAN RD STE 3, KENOSHA, WI 53143-5063
(224) 285-6006
Mailing address
6530 SHERIDAN RD STE 3, KENOSHA, WI 53143-5063
(224) 285-6006
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/09/2023
Last updated
04/10/2023
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