Provider Demographics
NPI:1770815797
Name:WEST, BENJAMIN THOMAS (LPCC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:THOMAS
Last Name:WEST
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5871 REEDYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ROUNDHILL
Mailing Address - State:KY
Mailing Address - Zip Code:42275-9411
Mailing Address - Country:US
Mailing Address - Phone:270-799-1658
Mailing Address - Fax:
Practice Address - Street 1:5871 REEDYVILLE RD
Practice Address - Street 2:
Practice Address - City:ROUNDHILL
Practice Address - State:KY
Practice Address - Zip Code:42275-9411
Practice Address - Country:US
Practice Address - Phone:270-799-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional