Healthcare Provider Details

I. General information

NPI: 1861190522
Provider Name (Legal Business Name): TINLEY EUTHYMIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 RICHARD AVE
BERKELEY IL
60163-1026
US

IV. Provider business mailing address

20015 S LAGRANGE RD # 1513
FRANKFORT IL
60423-3104
US

V. Phone/Fax

Practice location:
  • Phone: 708-554-3917
  • Fax: 708-273-5525
Mailing address:
  • Phone: 708-554-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. OLALEKAN MOSES FAPOHUNDA
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: DNP, APN
Phone: 708-554-3917