Healthcare Provider Details

I. General information

NPI: 1992422810
Provider Name (Legal Business Name): GREG ARTY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 GRAND AVE
WAUKEGAN IL
60085-2321
US

IV. Provider business mailing address

39063 N OGDEN LN
BEACH PARK IL
60083-3009
US

V. Phone/Fax

Practice location:
  • Phone: 847-377-8000
  • Fax:
Mailing address:
  • Phone: 847-693-8194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: