Healthcare Provider Details

I. General information

NPI: 1467212860
Provider Name (Legal Business Name): MATRIX MENTAL HEALTH LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 RICHARDS ST
JOLIET IL
60433-2745
US

IV. Provider business mailing address

PO BOX 9412
NAPERVILLE IL
60567-0412
US

V. Phone/Fax

Practice location:
  • Phone: 312-554-5431
  • Fax:
Mailing address:
  • Phone: 312-554-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BIKRAM SHARMA
Title or Position: OWNER
Credential: MD
Phone: 312-554-5431