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General NPI Number Information
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NPI Number | 1063193829
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Entity Type | Organization
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Legal Business Name | BETH PSYCHIATRY LLC
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 20855 S LAGRANGE RD STE 205
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City | FRANKFORT
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State | IL
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Zip | 60423-2043
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Country | US
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Telephone | 773-985-3539
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Fax |
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Provider Business Mailing Address
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Address Line | 360 BUTTERNUT TRL
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City | FRANKFORT
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State | IL
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Zip | 60423-1092
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Country | US
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Telephone | 773-782-7609
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. OLAJUMOKE ELIZABETH ADEKOYA
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Credential | NP
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Telephone | 773-985-3539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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