Provider Demographics
NPI:1407933567
Name:WEST, AMY L (MSW LMSW ACSW CSAT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:MSW LMSW ACSW CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15512 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2193
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14998 CLEVELAND ST
Practice Address - Street 2:SUITE G
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-8992
Practice Address - Country:US
Practice Address - Phone:616-842-0264
Practice Address - Fax:616-842-3161
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085108104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker