Provider Demographics
NPI:1013763747
Name:WESTLAKE CONSULTATION CENTER
Entity Type:Organization
Organization Name:WESTLAKE CONSULTATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERIERE
Authorized Official - Middle Name:
Authorized Official - Last Name:IZOBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-770-5120
Mailing Address - Street 1:PO BOX 50204
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92165-0204
Mailing Address - Country:US
Mailing Address - Phone:619-770-5120
Mailing Address - Fax:
Practice Address - Street 1:2616 MENLO AVE APT 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-4461
Practice Address - Country:US
Practice Address - Phone:619-770-5120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty