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General NPI Number Information
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NPI Number | 1225532849
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Entity Type | Organization
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Legal Business Name | CRADLESTONE, LLC
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 780 SE BAYSHORE DR # 201
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City | OAK HARBOR
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State | WA
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Zip | 98277-5701
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Country | US
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Telephone | 360-682-5519
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 891
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City | OAK HARBOR
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State | WA
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Zip | 98277-0891
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Country | US
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Telephone | 360-682-5519
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Fax |
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Authorized Official
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Title or Position | CEO/COUNSELOR
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Name | MR. CHRISTOPHER JOHN WIEGENSTEIN
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Credential | AS, BA, MS
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Telephone | 360-682-5519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 604194142
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 604194142
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 604194142
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License Number State | WA
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