Provider Demographics
NPI:1578867685
Name:WEST, GEORGE ROSS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ROSS
Last Name:WEST
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8374 S LOST MINE RD
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-5105
Mailing Address - Country:US
Mailing Address - Phone:480-622-1596
Mailing Address - Fax:
Practice Address - Street 1:8374 S LOST MINE RD
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-5105
Practice Address - Country:US
Practice Address - Phone:480-622-1596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 21345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health