Provider Demographics
NPI:1992175178
Name:WESTSIDE PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:WESTSIDE PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EUGSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-236-4460
Mailing Address - Street 1:313 PRICE PL
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3299
Mailing Address - Country:US
Mailing Address - Phone:608-236-4460
Mailing Address - Fax:608-236-4461
Practice Address - Street 1:313 PRICE PL
Practice Address - Street 2:SUITE 208
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3299
Practice Address - Country:US
Practice Address - Phone:608-236-4460
Practice Address - Fax:608-236-4461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3056101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty