Provider Demographics
NPI:1629375514
Name:PREVAILING WINDS INTERNATIONAL
Entity Type:Organization
Organization Name:PREVAILING WINDS INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:ASW
Authorized Official - Phone:925-484-6032
Mailing Address - Street 1:6327 BETHEL ISLAND
Mailing Address - Street 2:STE A 1011
Mailing Address - City:BETHEL ISLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94511
Mailing Address - Country:US
Mailing Address - Phone:925-848-6032
Mailing Address - Fax:
Practice Address - Street 1:6327 BETHEL ISLAND
Practice Address - Street 2:STE A 1011
Practice Address - City:BETHEL ISLAND
Practice Address - State:CA
Practice Address - Zip Code:94561
Practice Address - Country:US
Practice Address - Phone:925-848-6032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health