| Greater Lakes Behavioral Health Services Llc | |
|
3141 Willowcreek Rd Unit L3 Portage IN 46368-4468 | |
| (219) 706-3898 | |
| (219) 706-3899 |
| Full Name | Greater Lakes Behavioral Health Services Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3141 Willowcreek Rd Unit L3, Portage, Indiana |
| Authorized Official Name and Position | Roshanda Grayson-thomas (MANAGER) |
| Authorized Official Contact | 2197063898 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Greater Lakes Behavioral Health Services Llc 6212 Us Highway 6 # 147 Portage IN 46368-5057 Ph: (219) 331-8063 | Greater Lakes Behavioral Health Services Llc 3141 Willowcreek Rd Unit L3 Portage IN 46368-4468 Ph: (219) 706-3898 |
| NPI Number | 1932816923 |
|---|---|
| Provider Enumeration Date | 10/31/2022 |
| Last Update Date | 03/20/2023 |
| Certification Date | 03/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932816923 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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