Provider Demographics
NPI:1013635408
Name:WEST, KATRINA JEANNINE (QMHA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:JEANNINE
Last Name:WEST
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:JEANNINE
Other - Last Name:WIRTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1064
Mailing Address - Street 2:
Mailing Address - City:WILLAMINA
Mailing Address - State:OR
Mailing Address - Zip Code:97396-1064
Mailing Address - Country:US
Mailing Address - Phone:541-290-9201
Mailing Address - Fax:
Practice Address - Street 1:182 SW ACADEMY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1996
Practice Address - Country:US
Practice Address - Phone:503-623-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health