Provider Demographics
NPI:1902687932
Name:VITAL MINDS, LLC
Entity Type:Organization
Organization Name:VITAL MINDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ICKES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:513-268-8575
Mailing Address - Street 1:9292 STEEPLECHASE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4637
Mailing Address - Country:US
Mailing Address - Phone:513-268-8575
Mailing Address - Fax:513-268-2052
Practice Address - Street 1:9122 MONTGOMERY RD STE 18
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7746
Practice Address - Country:US
Practice Address - Phone:513-268-8575
Practice Address - Fax:512-268-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty