Provider Demographics
NPI:1598174773
Name:WEST, JAYNE ELYSE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:ELYSE
Last Name:WEST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:JAYNE
Other - Middle Name:ELYSE
Other - Last Name:HAVILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4126 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-3447
Mailing Address - Country:US
Mailing Address - Phone:810-241-6736
Mailing Address - Fax:
Practice Address - Street 1:4126 OAK ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-3447
Practice Address - Country:US
Practice Address - Phone:810-241-6736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010932011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical