Provider Demographics
NPI:1629152533
Name:WEST, COLLEEN DESIREE (LMFT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:DESIREE
Last Name:WEST
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 PORTOFINO DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6130
Mailing Address - Country:US
Mailing Address - Phone:760-433-6361
Mailing Address - Fax:
Practice Address - Street 1:105 N ROSE ST STE 211
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-3109
Practice Address - Country:US
Practice Address - Phone:760-224-5939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAIMF75847106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health