Provider Demographics
NPI:1861190522
Name:TINLEY EUTHYMIA LLC
Entity type:Organization
Organization Name:TINLEY EUTHYMIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLALEKAN
Authorized Official - Middle Name:MOSES
Authorized Official - Last Name:FAPOHUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN
Authorized Official - Phone:708-554-3917
Mailing Address - Street 1:20015 S LAGRANGE RD # 1513
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3104
Mailing Address - Country:US
Mailing Address - Phone:708-554-3917
Mailing Address - Fax:
Practice Address - Street 1:1038 RICHARD AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:IL
Practice Address - Zip Code:60163-1026
Practice Address - Country:US
Practice Address - Phone:708-554-3917
Practice Address - Fax:708-273-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service