Provider Demographics
NPI:1568137602
Name:WEST, BRAEDYN (CT)
Entity Type:Individual
Prefix:
First Name:BRAEDYN
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4653 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3298
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4653 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-3298
Practice Address - Country:US
Practice Address - Phone:614-875-2371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2024-01-07
Deactivation Date:2023-12-28
Deactivation Code:
Reactivation Date:2024-01-03
Provider Licenses
StateLicense IDTaxonomies
OHC.2405421-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor