Provider Demographics
NPI:1114906112
Name:WEST, GILBERT N (PHD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:N
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 1:700 HAYNES RD
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375-4050
Mailing Address - Country:US
Mailing Address - Phone:931-598-5913
Mailing Address - Fax:931-598-5913
Practice Address - Street 1:143 COLLEGE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MONTEAGLE
Practice Address - State:TN
Practice Address - Zip Code:37356-7004
Practice Address - Country:US
Practice Address - Phone:931-924-7792
Practice Address - Fax:931-924-7792
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3680539Medicaid
TN3680539Medicaid