Healthcare Provider Details

I. General information

NPI: 1659802122
Provider Name (Legal Business Name): WESTSIDE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 03/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 CENTER RIDGE RD BUILDING 3, SUITE 130
WESTLAKE OH
44145-5638
US

IV. Provider business mailing address

2660 GLENMORE DR
WESTLAKE OH
44145-3928
US

V. Phone/Fax

Practice location:
  • Phone: 216-295-5624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7303
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number7303
License Number StateOH

VIII. Authorized Official

Name: DR. ERIN CARTER
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 859-512-9921