Healthcare Provider Details

I. General information

NPI: 1063193829
Provider Name (Legal Business Name): BETH PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20855 S LAGRANGE RD STE 205
FRANKFORT IL
60423-2043
US

IV. Provider business mailing address

360 BUTTERNUT TRL
FRANKFORT IL
60423-1092
US

V. Phone/Fax

Practice location:
  • Phone: 773-985-3539
  • Fax:
Mailing address:
  • Phone: 773-782-7609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. OLAJUMOKE ELIZABETH ADEKOYA
Title or Position: CEO
Credential: NP
Phone: 773-985-3539