Provider Demographics
NPI:1437577608
Name:WESTMORELAND, MAXINE (LCDC, LPCI)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:WESTMORELAND
Suffix:
Gender:F
Credentials:LCDC, LPCI
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 20620
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79114-2620
Mailing Address - Country:US
Mailing Address - Phone:806-433-0257
Mailing Address - Fax:806-354-0011
Practice Address - Street 1:2901 SE 11TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79104-2515
Practice Address - Country:US
Practice Address - Phone:806-433-0257
Practice Address - Fax:806-354-0011
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12356101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)