Provider Demographics
NPI:1497024400
Name:HIRST, WESLEY RAYMOND (LPC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:RAYMOND
Last Name:HIRST
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 CANDLEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-2009
Mailing Address - Country:US
Mailing Address - Phone:816-617-2476
Mailing Address - Fax:816-671-4022
Practice Address - Street 1:5608 CANDLEBERRY DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-2009
Practice Address - Country:US
Practice Address - Phone:816-617-2476
Practice Address - Fax:816-671-4022
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000440101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional