Provider Demographics
NPI:1932471810
Name:WEST, JODY S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:S
Last Name:WEST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1344
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-1344
Mailing Address - Country:US
Mailing Address - Phone:337-332-2844
Mailing Address - Fax:337-332-5458
Practice Address - Street 1:328 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-1344
Practice Address - Country:US
Practice Address - Phone:337-332-2844
Practice Address - Fax:337-332-5458
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA49641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical