Provider Demographics
NPI:1134457609
Name:WEST, COLLEEN FOX (MFT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:FOX
Last Name:WEST
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 ELM ST
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1924
Mailing Address - Country:US
Mailing Address - Phone:510-412-2155
Mailing Address - Fax:
Practice Address - Street 1:1811 ELM ST
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1924
Practice Address - Country:US
Practice Address - Phone:510-412-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-21
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40568101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health