| NPI | 1952125700 |
|---|---|
| Former Legal Business Name | MIDWEST PUBLIC SAFETY PSYCHOLOGICAL SERVICES, LTD |
| Entity Type | Organization |
| Authorized Contact | GENESSA LEWIS Owner 708-942-7474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2024-11-08 |
| Last Update Date | 2024-12-02 |