Provider Demographics
NPI:1346078037
Name:WESTLAKE PSYCHIATRY & WELLNESS LLC
Entity type:Organization
Organization Name:WESTLAKE PSYCHIATRY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:406-570-1169
Mailing Address - Street 1:14535 WESTLAKE DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7775
Mailing Address - Country:US
Mailing Address - Phone:503-214-2431
Mailing Address - Fax:
Practice Address - Street 1:14535 WESTLAKE DR STE C
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7775
Practice Address - Country:US
Practice Address - Phone:503-214-2431
Practice Address - Fax:503-214-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty