Provider Demographics
NPI:1265166177
Name:ELITE PSYCHIATRY AND WELLNESS LLC
Entity type:Organization
Organization Name:ELITE PSYCHIATRY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEDINAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BALOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:708-271-2748
Mailing Address - Street 1:10010 W 190TH PL
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8752
Mailing Address - Country:US
Mailing Address - Phone:815-733-8019
Mailing Address - Fax:815-733-8019
Practice Address - Street 1:10010 W 190TH PL
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8752
Practice Address - Country:US
Practice Address - Phone:815-733-8019
Practice Address - Fax:815-733-8019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty