Provider Demographics
NPI:1700698271
Name:CEDARCREST BEHAVIORAL MEDICINE LLC
Entity type:Organization
Organization Name:CEDARCREST BEHAVIORAL MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANGAI
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, PMHNP-BC
Authorized Official - Phone:770-292-0854
Mailing Address - Street 1:1908 S WHIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5725
Mailing Address - Country:US
Mailing Address - Phone:770-292-0854
Mailing Address - Fax:509-732-9970
Practice Address - Street 1:1908 S WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5725
Practice Address - Country:US
Practice Address - Phone:770-292-0854
Practice Address - Fax:509-732-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty