Provider Demographics
NPI:1114147790
Name:WEST, BRIAN L (PHD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:WEST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5080
Mailing Address - Country:US
Mailing Address - Phone:843-572-9800
Mailing Address - Fax:
Practice Address - Street 1:9229 UNIVERSITY BLVD # F
Practice Address - Street 2:2B
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9150
Practice Address - Country:US
Practice Address - Phone:843-572-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC301103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6657Medicare ID - Type UnspecifiedMEDICARE NUMBER