Provider Demographics
NPI:1770022519
Name:WEST, PAUL CORDELL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:CORDELL
Last Name:WEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12101 N MACARTHUR BLVD
Mailing Address - Street 2:#310
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-1800
Mailing Address - Country:US
Mailing Address - Phone:405-819-6788
Mailing Address - Fax:
Practice Address - Street 1:4912 S WESTERN AVE
Practice Address - Street 2:STE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3838
Practice Address - Country:US
Practice Address - Phone:405-819-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKC001419787101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)