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General NPI Number Information
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NPI Number | 1952125700
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Entity Type | Organization
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Legal Business Name | MIDWEST PUBLIC SAFETY PSYCHOLOGICAL SERVICES, LTD
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 6601 NORTH AVE
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City | OAK PARK
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State | IL
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Zip | 60302-1084
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Country | US
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Telephone | 708-942-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 N NEWCASTLE AVE
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City | CHICAGO
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State | IL
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Zip | 60707-4422
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Country | US
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Telephone | 773-972-0288
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GENESSA LEWIS
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Credential | PSYD, RXP
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Telephone | 708-942-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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