Provider Demographics
NPI:1073668414
Name:WEST, MICHEL DAVID (QMHA)
Entity Type:Individual
Prefix:MR
First Name:MICHEL
Middle Name:DAVID
Last Name:WEST
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 SE MALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3817
Mailing Address - Country:US
Mailing Address - Phone:503-232-3902
Mailing Address - Fax:
Practice Address - Street 1:707 NW EVERETT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3517
Practice Address - Country:US
Practice Address - Phone:503-222-4906
Practice Address - Fax:503-222-3215
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered372600000XNursing Service Related ProvidersAdult Companion