Provider Demographics
NPI:1295554384
Name:BETHEL PSYCHIATRY LLC
Entity type:Organization
Organization Name:BETHEL PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUYEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LASAKI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:815-710-0387
Mailing Address - Street 1:24047 W LOCKPORT ST STE D
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2205
Mailing Address - Country:US
Mailing Address - Phone:815-710-0387
Mailing Address - Fax:
Practice Address - Street 1:24047 W LOCKPORT ST STE D
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2205
Practice Address - Country:US
Practice Address - Phone:815-710-0387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
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 - Single Specialty