Great Lakes Neuropsychology & Counseling Llc
LBN: Great Lakes Neuropsychology & Counseling Llc
Great Lakes Neuropsychology & Counseling Llc is an health care organization with primary practice located at 5758 Elaine Dr , Rockford IL 61108-3102. The organization recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Neuropsychologist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is the primary health care specialty.
Great Lakes Neuropsychology & Counseling Llc can be contacted via phone (815) 231-1280, or through Bong, Shaun A via phone (815) 231-1280.
Contact Information
Primary practice address
5758 Elaine Dr
Rockford IL 61108-3102
Phone: (815) 231-1280
Fax: (815) 231-1282
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical Neuropsychologist | 103G00000X | Illinois | |
| Behavioral Health & Social Service Providers / Clinical Neuropsychologist | 103G00000X | Illinois | |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | Illinois | |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | Illinois |
Profile Details
| NPI number | 1013030725 |
|---|---|
| LBN Legal business name | Great Lakes Neuropsychology & Counseling Llc |
| DBA Doing business as | |
| Authorized official | Bong, Shaun A PSY.D. |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 9th, 2007 |
| Last updated | Feb 5th, 2008 - about 16 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1013030725 | NPPES |
| Illinois | Other | 215368 | MEDICARE PTAN |
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