Provider Demographics
NPI:1598883753
Name:MCMATHIS-WEST, DARLENE (MA, LLPC, LBSW)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:MCMATHIS-WEST
Suffix:
Gender:F
Credentials:MA, LLPC, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W WALKER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1566
Mailing Address - Country:US
Mailing Address - Phone:989-224-5065
Mailing Address - Fax:989-224-9045
Practice Address - Street 1:108 W WALKER ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1566
Practice Address - Country:US
Practice Address - Phone:989-224-5065
Practice Address - Fax:989-224-9045
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional