MEDICARE: COGNIS PYSCHIATRIC SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1396699682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COGNIS PYSCHIATRIC SERVICES LLC

Provider Business Mailing Address
First Line	:	7117 N RIDGE BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-3503
Country	:	US
Telephone Number	:	773-234-5866
Fax Number	:	773-819-4550

Provider Business Practice Location Address
First Line	:	7117 N RIDGE BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-3503
Country	:	US
Telephone Number	:	773-234-5866
Fax Number	:	773-819-4550

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MARIAM BELLO
Credential	:	PMHNP-BC
Telephone Number	:	773-234-5866

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	03/18/2026

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