# GREAT LAKES CLINICAL GROUP, P.C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194673889
- **Authorized official:** JONATHAN SNIPES (OWNER)
- **Authorized official phone:** (213) 827-3038

## Contact information

- **Practice address:** 2709 PONTIAC LAKE RD FL 1, WATERFORD, MI 48328-2653
- **Practice address phone:** (313) 758-6857
- **Mailing address:** 2709 PONTIAC LAKE RD FL 1, WATERFORD, MI 48328-2653
- **Mailing address phone:** (313) 758-6857

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 103TC1900X | Counseling Psychologist | — | NULL | — |
| 103TC1900X | Counseling Psychologist | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 03/18/2026
- **Last updated:** 03/18/2026