Provider Demographics
NPI:1669116810
Name:GREAT OAKS CONSULTING SERVICES LLC
Entity type:Organization
Organization Name:GREAT OAKS CONSULTING SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ILVA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:VANVALKENBURGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-885-0080
Mailing Address - Street 1:305 W SILVER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217
Mailing Address - Country:US
Mailing Address - Phone:414-885-0080
Mailing Address - Fax:414-885-0081
Practice Address - Street 1:305 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217
Practice Address - Country:US
Practice Address - Phone:414-885-0080
Practice Address - Fax:414-885-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty