Provider Demographics
NPI:1669769972
Name:WESTLAKE PSYCHOTHERAPY INCORPORATED
Entity type:Organization
Organization Name:WESTLAKE PSYCHOTHERAPY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:HILTS
Authorized Official - Last Name:ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-587-1107
Mailing Address - Street 1:5524 BEE CAVE RD
Mailing Address - Street 2:BUILDING E, 2ND FLOOR
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5245
Mailing Address - Country:US
Mailing Address - Phone:512-587-1107
Mailing Address - Fax:
Practice Address - Street 1:5524 BEE CAVE RD
Practice Address - Street 2:BUILDING E, 2ND FLOOR
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5245
Practice Address - Country:US
Practice Address - Phone:512-587-1107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty