Healthcare Provider Details

I. General information

NPI: 1497454342
Provider Name (Legal Business Name): CRESCENT OUTPATIENT AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 SE 36TH ST STE 205
MERCER ISLAND WA
98040-3840
US

IV. Provider business mailing address

9725 SE 36TH ST STE 205
MERCER ISLAND WA
98040-3840
US

V. Phone/Fax

Practice location:
  • Phone: 425-495-0727
  • Fax:
Mailing address:
  • Phone: 425-495-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: REBEKAH VIGILEOS
Title or Position: CEO
Credential: PMHNP
Phone: 480-434-9153