| Headwater Psychotherapy, Llc | |
|
1800 Bridgegate St Ste 108 Westlake Village CA 91361-1468 | |
| (805) 405-6299 | |
| Not Available |
| Full Name | Headwater Psychotherapy, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1800 Bridgegate St Ste 108, Westlake Village, California |
| Authorized Official Name and Position | Lance Homer Rachels (PSYCHOTHERAPIST) |
| Authorized Official Contact | 8054056299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Headwater Psychotherapy, Llc 1684 Wellington Pl Westlake Village CA 91361-1535 Ph: (805) 469-0469 | Headwater Psychotherapy, Llc 1800 Bridgegate St Ste 108 Westlake Village CA 91361-1468 Ph: (805) 405-6299 |
| NPI Number | 1447069091 |
|---|---|
| Provider Enumeration Date | 01/07/2025 |
| Last Update Date | 01/07/2025 |
| Certification Date | 01/07/2025 |
| Medicare PECOS PAC ID | 7113456609 |
|---|---|
| Medicare Enrollment ID | O20250129000780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447069091 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Lance Homer Rachels |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1972218394 PECOS PAC ID: 0840729331 Enrollment ID: I20250211001092 |
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