Provider Demographics
NPI:1497454342
Name:CRESCENT OUTPATIENT AND WELLNESS PLLC
Entity Type:Organization
Organization Name:CRESCENT OUTPATIENT AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGILEOS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:480-434-9153
Mailing Address - Street 1:9725 SE 36TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3840
Mailing Address - Country:US
Mailing Address - Phone:425-495-0727
Mailing Address - Fax:
Practice Address - Street 1:2737 78TH AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2843
Practice Address - Country:US
Practice Address - Phone:206-695-2707
Practice Address - Fax:425-364-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility