Provider Demographics
NPI:1326228719
Name:WEST PSYCHOTHERAPY SERVICES LLC
Entity Type:Organization
Organization Name:WEST PSYCHOTHERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC BCD
Authorized Official - Phone:301-512-0445
Mailing Address - Street 1:7700 OLD BRANCH AVE STE B105
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1628
Mailing Address - Country:US
Mailing Address - Phone:301-512-0445
Mailing Address - Fax:
Practice Address - Street 1:7700 OLD BRANCH AVE STE B105
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1628
Practice Address - Country:US
Practice Address - Phone:301-512-0445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD036081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003247D40Medicare PIN