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General NPI Number Information
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NPI Number | 1992175178
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Entity Type | Organization
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Legal Business Name | WESTSIDE PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 313 PRICE PL SUITE 208
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City | MADISON
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State | WI
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Zip | 53705-3299
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Country | US
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Telephone | 608-236-4460
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Fax | 608-236-4461
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Provider Business Mailing Address
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Address Line | 313 PRICE PL SUITE 208
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City | MADISON
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State | WI
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Zip | 53705-3299
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Country | US
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Telephone | 608-236-4460
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Fax | 608-236-4461
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDRA LEE EUGSTER
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Credential | PH.D.
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Telephone | 608-236-4460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3056
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License Number State | WI
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