Provider Demographics
NPI:1811042591
Name:WEST, JOHNNIE LYNNETTE (MS,LPC,MHP)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:LYNNETTE
Last Name:WEST
Suffix:
Gender:F
Credentials:MS,LPC,MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 497
Mailing Address - Street 2:
Mailing Address - City:VALLIANT
Mailing Address - State:OK
Mailing Address - Zip Code:74764-9793
Mailing Address - Country:US
Mailing Address - Phone:580-743-6214
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 497
Practice Address - Street 2:
Practice Address - City:VALLIANT
Practice Address - State:OK
Practice Address - Zip Code:74764-9793
Practice Address - Country:US
Practice Address - Phone:580-743-6214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3332101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK101Y00000XMedicaid