Provider Demographics
NPI:1275921801
Name:WEST, JENNY (MCP, LPC, LADC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:MCP, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:NEWKIRK
Mailing Address - State:OK
Mailing Address - Zip Code:74647-0153
Mailing Address - Country:US
Mailing Address - Phone:580-749-9789
Mailing Address - Fax:
Practice Address - Street 1:400 E CENTRAL AVE STE 505E
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-5429
Practice Address - Country:US
Practice Address - Phone:580-749-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional