Longevity Therapy and Wellness of Grayslake LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

LONGEVITY THERAPY AND WELLNESS OF GRAYSLAKE LLC

Practice address

100 S Atkinson Rd Ste 213
Grayslake, IL 60030-7820

Phone

(847) 668-8813

NPI assigned

Mar 12, 2026

Organization subpart

No

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

Authorized official

Name

Mr. Brian SchultzNPI 1013554575

Title

Owner/Therapist

Phone

(847) 668-8813

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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

• Brian Schultz, LCSW

  • Clinical Social Worker
  • Grayslake, IL
  • NPI 1013554575
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1773273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779062400000",
    "number": "1124975776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 WALTON LN",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600303425",
            "telephone_number": "847-668-8813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S ATKINSON RD STE 213",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307820",
            "telephone_number": "847-668-8813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY THERAPY AND WELLNESS OF GRAYSLAKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-12",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "847-668-8813",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daisha Lewis
• Trevor Warren Lissoos, M.D.
• Little Heroes LLC
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• Pier London
• Susan D Love, L.C.S.W
• Lisa Lucchese, LPC
• Amy Luetke, LCSW
• Tristina Maritza Mary Lynch, LPC
• Tracy N Lyndon

• Clinical Social Worker in Grayslake, IL
• Providers in Grayslake, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.