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General NPI Number Information
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NPI Number | 1164371969
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Entity Type | Organization
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Legal Business Name | GRANTED MENTAL HEALTH SERVICES PLLC
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Dates
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Enumeration Date | 01/26/2026
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 2512 ACHILLES LN
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-3945
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Country | US
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Telephone | 815-688-8130
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Fax | 815-205-5075
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Provider Business Mailing Address
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Address Line | 2512 ACHILLES LN
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-3945
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Country | US
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Telephone | 815-688-8130
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Fax | 815-205-5075
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | AL BERRY
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Credential |
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Telephone | 469-915-4211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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