Provider Demographics
NPI:1871234781
Name:WEST, DESTINY MARIE
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:MARIE
Last Name:WEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 BONHOMME AVENUE
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105
Mailing Address - Country:US
Mailing Address - Phone:636-202-0693
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:7777 BONHOMME AVENUE
Practice Address - Street 2:SUITE 1800
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105
Practice Address - Country:US
Practice Address - Phone:636-202-0693
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician