Provider Demographics
NPI:1689203549
Name:WEST, HEATHER GAIL (LMFT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:GAIL
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 1:2113 RUBY RED BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6115
Mailing Address - Country:US
Mailing Address - Phone:352-394-0573
Mailing Address - Fax:
Practice Address - Street 1:NEUMIND WELLNESS GROUP
Practice Address - Street 2:2113 RUBY RED BLVD SUITE D
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714
Practice Address - Country:US
Practice Address - Phone:352-394-0573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3281106H00000X
FLMT4289106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114350800Medicaid