Optimal Vitality

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

OPTIMAL VITALITY

Practice address

200 S Frontage Rd Ste 324
Burr Ridge, IL 60527-6953

Phone

(630) 360-1173

Fax

(331) 992-2358

NPI assigned

Sep 29, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brandi Kristen Boan, PSYDNPI 1780862219

Title

Owner

Phone

(630) 649-2819

Specialties & licenses 8

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brandi Kristen Boan, PSYD

  • Clinical Psychologist
  • Sandwich, IL
  • NPI 1780862219

  Professional

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1457131328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S FRONTAGE RD STE 324",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276953",
            "telephone_number": "630-360-1173",
            "fax_number": "331-299-2358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S FRONTAGE RD STE 324",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276953",
            "telephone_number": "630-360-1173",
            "fax_number": "331-992-2358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL VITALITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-29",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "BOAN",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_middle_name": "KRISTEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-649-2819",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurodevelopmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon O'Brien
• Sarah Marie O'Connor, PTA
• Timothy A O'Donohue, LCPC
• Cathleen O'Hare
• Nicolette C Ogier, OTR/L
• Ora Pro Nobis Corporation
• Nina Alisa Ortega, CCC-SLP
• Joanna Y Ortiz, MD
• Mina Kharot Paiman, MD
• Pain and Rehab Specialists of Greater Chicago, LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Burr Ridge, IL
• Providers in Burr Ridge, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.