Provider Demographics
NPI:1063193829
Name:BETH PSYCHIATRY LLC
Entity type:Organization
Organization Name:BETH PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLAJUMOKE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ADEKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:773-985-3539
Mailing Address - Street 1:360 BUTTERNUT TRL
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1092
Mailing Address - Country:US
Mailing Address - Phone:773-782-7609
Mailing Address - Fax:
Practice Address - Street 1:20855 S LAGRANGE RD STE 205
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-2043
Practice Address - Country:US
Practice Address - Phone:773-985-3539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty