Provider Demographics
NPI:1679761415
Name:WEST, JOHN FRANKLIN JR (MED/EDS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FRANKLIN
Last Name:WEST
Suffix:JR
Gender:M
Credentials:MED/EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 N SUNDANCE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3725
Mailing Address - Country:US
Mailing Address - Phone:407-580-8108
Mailing Address - Fax:
Practice Address - Street 1:505 PARK AVE N
Practice Address - Street 2:SUITE 212
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3268
Practice Address - Country:US
Practice Address - Phone:407-539-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT1073101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor