Provider Demographics
NPI:1356152169
Name:PSYGENIC HEALTH INC
Entity type:Organization
Organization Name:PSYGENIC HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUSOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:708-879-2975
Mailing Address - Street 1:920 175TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2077
Mailing Address - Country:US
Mailing Address - Phone:708-879-2975
Mailing Address - Fax:708-365-2949
Practice Address - Street 1:920 175TH ST STE 6
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2077
Practice Address - Country:US
Practice Address - Phone:708-879-2975
Practice Address - Fax:708-365-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)