Provider Demographics
NPI:1629392857
Name:WEST, LAURA A (LPCC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:WEST
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:CREEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9601 RHODE ISLAND CT STE B
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101
Mailing Address - Country:US
Mailing Address - Phone:575-749-4376
Mailing Address - Fax:575-904-9020
Practice Address - Street 1:100 S AVENUE A
Practice Address - Street 2:B7
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-5917
Practice Address - Country:US
Practice Address - Phone:575-749-4376
Practice Address - Fax:575-904-9020
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0130471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional