Healthcare Provider Details

I. General information

NPI: 1568528040
Provider Name (Legal Business Name): WESTSIDE COMMUNITY MENTAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 MISSION ST STE 310
SAN FRANCISCO CA
94103-2486
US

IV. Provider business mailing address

1153 OAK ST
SAN FRANCISCO CA
94117-2216
US

V. Phone/Fax

Practice location:
  • Phone: 415-581-0449
  • Fax: 415-581-0458
Mailing address:
  • Phone: 415-431-9000
  • Fax: 415-431-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BEA STEPHENS
Title or Position: INTERIM CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 415-431-9000