NPIMap

Grand Oaks Behavioral Health LLC

Organization Active NPI Clinical Psychologist · Libertyville, IL

NPI 1124242359 · NPPES record last updated Oct 6, 2021

Key facts

NPI
1124242359
Entity type
Organization (NPI type 2)
Primary specialty
Clinical Psychologist 103TC0700X
Legal business name
GRAND OAKS BEHAVIORAL HEALTH LLC
Practice address
1800 Hollister Dr
Suite 201
Libertyville, IL 60048-5263
Phone
(847) 549-1189
Fax
(847) 932-4066
NPI assigned
Apr 11, 2007
Organization subpart
No

Authorized official

Name
Dr. Marina Shakhman, PSY.D. NPI 1972537157
Title
Clinical Director
Phone
(847) 549-1189

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 25

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070724000609 IL Part B Supplier - Clinic/Group Practice 2163523903 Receives reassigned benefits from 16 practitioners
Practice locations: Libertyville, IL

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist
Group: 193400000X SINGLE SPECIALTY GROUP		 103TC0700X Yes

Addresses

Primary practice location

1800 Hollister Dr
Suite 201
Libertyville, IL 60048-5263

Mailing address

1800 Hollister Dr
Suite 201
Libertyville, IL 60048-5263
Phone (847) 549-1189

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 6, 2021.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633478400000",
    "number": "1124242359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 HOLLISTER DR",
            "address_2": "SUITE 201",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485263",
            "telephone_number": "847-549-1189",
            "fax_number": "847-932-4066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 HOLLISTER DR",
            "address_2": "SUITE 201",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485263",
            "telephone_number": "847-549-1189",
            "fax_number": "847-932-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND OAKS BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A",
        "authorized_official_last_name": "SHAKHMAN",
        "authorized_official_first_name": "MARINA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "847-549-1189",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

All providers in Libertyville, IL · Clinical Psychologist in Illinois

Sources for this page

Verify at the official NPI Registry.