Provider Demographics
NPI:1114566478
Name:WEST THERAPEUTIC CONSULTATION SERVICES, LLC
Entity Type:Organization
Organization Name:WEST THERAPEUTIC CONSULTATION SERVICES, LLC
Other - Org Name:WEST THERAPEUTIC CONSULTATION SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-234-9109
Mailing Address - Street 1:21 LUBRANO LN
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-4278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 FAIRWAY TER
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2321
Practice Address - Country:US
Practice Address - Phone:856-787-7150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health