Provider Demographics
NPI:1578523775
Name:WESTLAKE CLINIC, LLC
Entity Type:Organization
Organization Name:WESTLAKE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:SUHR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:414-327-5200
Mailing Address - Street 1:10533 W NATIONAL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2041
Mailing Address - Country:US
Mailing Address - Phone:414-327-5200
Mailing Address - Fax:414-327-5400
Practice Address - Street 1:10533 W NATIONAL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2041
Practice Address - Country:US
Practice Address - Phone:414-327-5200
Practice Address - Fax:414-327-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2395261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2395OtherOUTPAT MENTLHEALTH CLINIC