Provider Demographics
NPI:1770840134
Name:WEST, MONTREY DENISE (BA)
Entity Type:Individual
Prefix:
First Name:MONTREY
Middle Name:DENISE
Last Name:WEST
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:MONTREY
Other - Middle Name:DENISE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:6064 W BRITTON RD APT BD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-2538
Mailing Address - Country:US
Mailing Address - Phone:405-882-0896
Mailing Address - Fax:
Practice Address - Street 1:7908 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4950
Practice Address - Country:US
Practice Address - Phone:405-440-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200063170Medicaid