Provider Demographics
NPI:1750004412
Name:WESTLAKE, SIDNEY ELIZABETH LEE
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:ELIZABETH LEE
Last Name:WESTLAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 BELMONT RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-4325
Mailing Address - Country:US
Mailing Address - Phone:931-952-2728
Mailing Address - Fax:
Practice Address - Street 1:268 VETERANS PKWY STE 6
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-6431
Practice Address - Country:US
Practice Address - Phone:629-207-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician