Active NPI
County of Lake
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Park City, IL
National Provider Identifier
1194638940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Legal business name
- COUNTY OF LAKE
- Practice address
- 4120 Greenleaf CT Apt 311
Park City, IL 60085-7932 - Phone
- (847) 377-8000
- NPI assigned
- Sep 23, 2026
- Last updated
- Oct 22, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sam Johnson
- Title
- Deputy Executive Director
- Phone
- (847) 377-8000
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Primary | ||
| Mental Illness Community Based Residential Treatment Facility | 320800000X |
Addresses
Primary practice location
4120 Greenleaf CT Apt 311
Park City, IL 60085-7932
Mailing address
3010 Grand Ave
Waukegan, IL 60085-2321
Phone (847) 377-8800
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790121600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1792627200000",
"number": "1194638940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3010 GRAND AVE",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600852321",
"telephone_number": "847-377-8800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4120 GREENLEAF CT APT 311",
"city": "PARK CITY",
"state": "IL",
"postal_code": "600857932",
"telephone_number": "847-377-8000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COUNTY OF LAKE",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-23",
"last_updated": "2026-10-22",
"certification_date": "2026-10-22",
"status": "A",
"authorized_official_last_name": "JOHNSON",
"authorized_official_first_name": "SAM",
"authorized_official_title_or_position": "DEPUTY EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "847-377-8000"
},
"taxonomies": [
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": true
},
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Park City, IL
- Bruce A Bever, DPM
- Bruce Bever DPM LLC
- Milagritos Edith Caghan
- Marlin Cervantes, APRN, FNP-BC
- Barbara Contreras
- County of Lake
- County of Lake (Lake County Health Department and Community Health Center)
- County of Lake (Lake County Health Department and Community Health Center)
- County of Lake
- County of Lake
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.