Provider Demographics
NPI:1245469139
Name:WEST, KARLA J (PHD, LCPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:KARLA
Middle Name:J
Last Name:WEST
Suffix:
Gender:F
Credentials:PHD, LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 S MEADOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83631-4135
Mailing Address - Country:US
Mailing Address - Phone:209-392-4250
Mailing Address - Fax:
Practice Address - Street 1:59 S MEADOW CREEK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:ID
Practice Address - Zip Code:83631-4135
Practice Address - Country:US
Practice Address - Phone:208-392-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-2730101YM0800X, 101YP2500X
IDLMFT-2729106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist