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General NPI Number Information
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NPI Number | 1639542681
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Entity Type | Organization
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Legal Business Name | MYSI CORPORATION
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 3001 W 111TH ST SUITE 103
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City | CHICAGO
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State | IL
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Zip | 60655-2240
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Country | US
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Telephone | 773-840-4600
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Fax | 773-840-4606
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Provider Business Mailing Address
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Address Line | 3001 W 111TH ST SUITE 103
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City | CHICAGO
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State | IL
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Zip | 60655-2240
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Country | US
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Telephone | 773-840-4600
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Fax | 773-840-4606
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MRS. TOLEDA HART
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Credential |
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Telephone | 773-840-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 15011
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 15011
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License Number State | IL
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