Provider Demographics
NPI:1326709908
Name:WEST, BRIAN HANTZ (LMHC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:HANTZ
Last Name:WEST
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 PARK AVE STE 4006
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3799
Mailing Address - Country:US
Mailing Address - Phone:516-350-8564
Mailing Address - Fax:516-874-2477
Practice Address - Street 1:3375 PARK AVE STE 4006
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3799
Practice Address - Country:US
Practice Address - Phone:516-350-8564
Practice Address - Fax:516-874-2477
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013147101YM0800X
NYP099296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty