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General NPI Number Information
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NPI Number | 1477011310
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Entity Type | Organization
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Legal Business Name | CENTER FOR INTEGRATIVE PSYCHIATRY LLC
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 04/23/2023
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Provider Practice Location Address
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Address Line | 8745 W HIGGINS RD STE 110
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City | CHICAGO
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State | IL
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Zip | 60631-2753
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Country | US
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Telephone | 224-361-3301
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Fax | 405-337-9658
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Provider Business Mailing Address
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Address Line | 8745 W HIGGINS RD STE 110
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City | CHICAGO
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State | IL
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Zip | 60631-2753
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Country | US
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Telephone | 224-361-3301
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Fax | 405-337-9658
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Authorized Official
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Title or Position | OWNER
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Name | DR. BERNADETTE MIETUS STEVENSON
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Credential | MD, PHD
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Telephone | 224-361-3301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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