Organization
GREAT LAKES PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN ISRAEL (MANAGER)
(561) 318-1474
Entity
Organization
Contact information
Practice address
2328 10TH AVE N STE 500, LAKE WORTH BEACH, FL 33461-6615
(561) 318-1474
Mailing address
5640 W MAPLE RD STE 101, W BLOOMFIELD, MI 48322-3717
(561) 318-1474
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
04/29/2025
Last updated
06/09/2025
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