Great Lakes Neuropsychology & Counseling LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

GREAT LAKES NEUROPSYCHOLOGY & COUNSELING LLC

Practice address

5758 Elaine Dr
Rockford, IL 61108-3102

Phone

(815) 231-1280

Fax

(815) 231-1282

NPI assigned

Apr 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shaun A Bong, PSY.D.

Title

Licensed Clinical Psychologist/Memb

Phone

(815) 231-1280

Specialties & licenses 4

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Martha Crotts

  • Child & Adolescent Psychiatry Physician
  • Rockford, IL
  • NPI 1174652457
  NPD (past)
• Megan A Smick, PH.D.

  • Clinical Neuropsychologist
  • Rockford, IL
  • NPI 1972523421
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202169600000",
    "number": "1013030725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5758 ELAINE DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611083102",
            "telephone_number": "815-231-1280",
            "fax_number": "815-231-1282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5758 ELAINE DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611083102",
            "telephone_number": "815-231-1280",
            "fax_number": "815-231-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES NEUROPSYCHOLOGY & COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2008-02-05",
        "status": "A",
        "authorized_official_last_name": "BONG",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST/MEMB",
        "authorized_official_telephone_number": "815-231-1280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "215368",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aleah Aaron Grant, NP
• Ronald S Grant, MD
• Courtney Leanne Gray, ATC
• Dale R Gray, M.D.
• Sarah Elizabeth Gray
• Great Smiles of Rockford
• Great Smiles of Rockford, LTD
• Christopher A Green, MD
• Christy Green, L.S.W.
• Daniel Robert Green, DNP, NP-C

• Clinical Psychologist in Rockford, IL
• Providers in Rockford, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.