Provider Demographics
NPI:1558340828
Name:WESTBROOK, JOHN MICHAEL (PHD LPCC LMSW)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:WESTBROOK
Suffix:
Gender:M
Credentials:PHD LPCC LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W BROADWAY
Mailing Address - Street 2:STE 1
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240
Mailing Address - Country:US
Mailing Address - Phone:505-393-0692
Mailing Address - Fax:505-393-0796
Practice Address - Street 1:215 W BROADWAY
Practice Address - Street 2:STE 1
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240
Practice Address - Country:US
Practice Address - Phone:505-393-0692
Practice Address - Fax:505-393-0796
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75058812Medicaid