| Grand Oaks Behavioral Health Llc | |
|
1800 Hollister Dr Suite 201 Libertyville IL 60048-5263 | |
| (847) 549-1189 | |
| (847) 932-4066 |
| Full Name | Grand Oaks Behavioral Health Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1800 Hollister Dr, Libertyville, Illinois |
| Authorized Official Name and Position | Marina Shakhman (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8475491189 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Oaks Behavioral Health Llc 1800 Hollister Dr Suite 201 Libertyville IL 60048-5263 Ph: (847) 549-1189 | Grand Oaks Behavioral Health Llc 1800 Hollister Dr Suite 201 Libertyville IL 60048-5263 Ph: (847) 549-1189 |
| NPI Number | 1124242359 |
|---|---|
| Provider Enumeration Date | 04/11/2007 |
| Last Update Date | 10/06/2021 |
| Certification Date | 10/06/2021 |
| Medicare PECOS PAC ID | 2163523903 |
|---|---|
| Medicare Enrollment ID | O20070724000609 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124242359 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jauren D Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831110220 PECOS PAC ID: 0042116659 Enrollment ID: I20050303000761 |
| Provider Name | Angela Sue Eads |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851368955 PECOS PAC ID: 1658302278 Enrollment ID: I20050824000036 |
| Provider Name | Debra P Wolff |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558452573 PECOS PAC ID: 5991723124 Enrollment ID: I20051107000587 |
| Provider Name | Christine V Petersen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033217385 PECOS PAC ID: 7113948126 Enrollment ID: I20051216000703 |
| Provider Name | Marina Shakhman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972537157 PECOS PAC ID: 7911916200 Enrollment ID: I20060414000011 |
| Provider Name | Rebecca E Weitz-rice |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295855971 PECOS PAC ID: 4183701782 Enrollment ID: I20080611000748 |
| Provider Name | Marisa M Kunz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669625406 PECOS PAC ID: 2860772399 Enrollment ID: I20161129001891 |
| Provider Name | Abby L Merel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013403518 PECOS PAC ID: 7113263492 Enrollment ID: I20190108000265 |
| Provider Name | Frances J Pacheco |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881783389 PECOS PAC ID: 9335481225 Enrollment ID: I20190424002072 |
| Provider Name | Benjamin Lee Michaels |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205579034 PECOS PAC ID: 3375925183 Enrollment ID: I20220726002471 |
| Provider Name | Mary Catherine Mae Navarro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750026886 PECOS PAC ID: 7214312503 Enrollment ID: I20220922003129 |
| Provider Name | Carol L Dreyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598865875 PECOS PAC ID: 4688027204 Enrollment ID: I20240131001385 |
| Provider Name | Ellen Rodman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689001182 PECOS PAC ID: 7618419516 Enrollment ID: I20240606003249 |
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