Provider Demographics
NPI:1225105422
Name:WEST, LYNN L (MS, BCETS, LCPC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:MS, BCETS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 GINGERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7278
Mailing Address - Country:US
Mailing Address - Phone:410-573-1140
Mailing Address - Fax:410-573-0903
Practice Address - Street 1:410 ROWE BLVD
Practice Address - Street 2:WEST ANNAPOLIS-GLENCO BUILDING
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1585
Practice Address - Country:US
Practice Address - Phone:410-263-6368
Practice Address - Fax:410-573-0903
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC 1106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9730006Medicaid