Healthcare Provider Details

I. General information

NPI: 1689205338
Provider Name (Legal Business Name): VEST THURSTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 WOODLAND SQUARE LOOP SE
LACEY WA
98503-1045
US

IV. Provider business mailing address

605 WOODLAND SQUARE LOOP SE
LACEY WA
98503-1045
US

V. Phone/Fax

Practice location:
  • Phone: 844-949-8888
  • Fax: 360-764-8421
Mailing address:
  • Phone: 844-949-8888
  • Fax: 360-764-8421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD ALLEN KRESCH
Title or Position: MANAGER
Credential:
Phone: 212-243-5565