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General NPI Number Information
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NPI Number | 1427880822
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Entity Type | Organization
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Legal Business Name | WESTSIDE THERAPY
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Dates
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Enumeration Date | 08/15/2024
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 2863 NW CROSSING DR STE 212
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City | BEND
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State | OR
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Zip | 97703-7190
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Country | US
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Telephone | 541-948-7032
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Fax |
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Provider Business Mailing Address
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Address Line | 1866 NW IOWA AVE
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City | BEND
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State | OR
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Zip | 97703-1010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | KARI JOHANNSEN
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Credential | LCSW
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Telephone | 541-301-6591
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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 |
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License Number State |
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