Provider Demographics
NPI:1881561215
Name:VIBRANT PSYCHE LLC
Entity type:Organization
Organization Name:VIBRANT PSYCHE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GEATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-869-2254
Mailing Address - Street 1:PO BOX 1071
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-6171
Mailing Address - Country:US
Mailing Address - Phone:860-245-9883
Mailing Address - Fax:
Practice Address - Street 1:378 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095
Practice Address - Country:US
Practice Address - Phone:860-245-9883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health