Provider Demographics
NPI:1013635408
Name:WEST, KATRINA JEANNINE (QMHP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:JEANNINE
Last Name:WEST
Suffix:
Gender:
Credentials:QMHP
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:JEANNINE
Other - Last Name:WIRTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PROF COUNSELOR ASSOC
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0254
Mailing Address - Country:US
Mailing Address - Phone:541-464-3807
Mailing Address - Fax:
Practice Address - Street 1:615 5TH ST # 300
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9199
Practice Address - Country:US
Practice Address - Phone:541-708-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional