Great Lakes Psychotherapy LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

GREAT LAKES PSYCHOTHERAPY LLC

Practice address

2328 10TH Ave N Ste 500
Lake Worth Beach, FL 33461-6615

Phone

(561) 318-1474

NPI assigned

Apr 29, 2025

Last updated

Jun 9, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ryan IsraelNPI 1508565003

Title

Manager

Phone

(561) 318-1474

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ryan A Israel

  • Social Worker
  • NPI 1508565003
  NPD (past) Authorized official

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

{
    "created_epoch": "1745884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749427200000",
    "number": "1114715083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5640 W MAPLE RD STE 101",
            "city": "W BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223717",
            "telephone_number": "561-318-1474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2328 10TH AVE N STE 500",
            "city": "LAKE WORTH BEACH",
            "state": "FL",
            "postal_code": "334616615",
            "telephone_number": "561-318-1474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-29",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A",
        "authorized_official_last_name": "ISRAEL",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "561-318-1474"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rainer Jean Goldberg
• Daniuska Gomez
• Melissa Gonzalez Garcia
• Priscilla Gonzalez
• Milaidy Gonzalo
• Karen Susan Grimes
• Andrea Hanner, LCSW
• Hello Sunshine Speech and Language Therapy, Inc.
• Hestia Healthcare at Home, LLC (Nurse on Call)
• Heather Howard, LICSW

• Mental Health Clinic/Center (Including Community Mental Health Center) in Lake Worth Beach, FL
• Providers in Lake Worth Beach, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; 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.