Greater Lakes Behavioral Health Services LLC

Primary specialty

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

Legal business name

GREATER LAKES BEHAVIORAL HEALTH SERVICES LLC

Practice address

3141 Willowcreek Rd Unit L3
Portage, IN 46368-4468

Phone

(219) 706-3898

Fax

(219) 706-3899

NPI assigned

Oct 31, 2022

Last updated

Mar 20, 2023By 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

Roshanda Grayson-Thomas, APRN PMHNPNPI 1619415874

Title

Manager

Phone

(219) 706-3898

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.

• Roshanda Grayson-Thomas, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Portage, IN
  • NPI 1619415874
  NPD Authorized official

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

{
    "created_epoch": "1667174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679270400000",
    "number": "1932816923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6212 US HIGHWAY 6 # 147",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463685057",
            "telephone_number": "219-331-8063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3141 WILLOWCREEK RD UNIT L3",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684468",
            "telephone_number": "219-706-3898",
            "fax_number": "219-706-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER LAKES BEHAVIORAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-31",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A",
        "authorized_official_last_name": "GRAYSON-THOMAS",
        "authorized_official_first_name": "ROSHANDA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "219-706-3898",
        "authorized_official_credential": "APRN PMHNP"
    },
    "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": []
}

• Meghan Goranson, PTA
• Cimone Lynae Gordon
• Lisa Gorski
• Roshanda Grayson-Thomas, APRN
• Great Lakes Senior Care, LLC (Home Helpers)
• L. Allen Grecula
• Darcie A Gresham, OTR
• Stephanie L. Grider, DMD
• Margaret Eileen Griffith, DDS
• Guardian Medical Transportation LLC,

• Mental Health Clinic/Center (Including Community Mental Health Center) in Portage, IN
• Providers in Portage, IN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; 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.