Great Lakes Psychotherapy LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Lake Worth Beach, FL. Organization (NPI-2).
NPI number1114715083
StatusActive
Last updated in NPPESJun 9, 2025
Details
- NPI
- 1114715083
- Entity type
- Organization (NPI-2)
- Legal business name
- Great Lakes Psychotherapy LLC
- Organization subpart
- No
- Enumeration date
- Apr 29, 2025
- Certification date
- Jun 9, 2025
- Last updated
- Jun 9, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
2328 10th Ave N Ste 500Lake Worth Beach, FL 33461-6615
Phone 561-318-1474
Mailing address
5640 W Maple Rd Ste 101W Bloomfield, MI 48322-3717
Phone 561-318-1474
Authorized official
Ryan Israel
Manager
5613181474
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