Provider Demographics
NPI:1255351912
Name:WEST, JOHN TIMOTHY (MA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TIMOTHY
Last Name:WEST
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 JULIA ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-1292
Mailing Address - Country:US
Mailing Address - Phone:937-484-6864
Mailing Address - Fax:937-653-3482
Practice Address - Street 1:430 S MAIN ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2402
Practice Address - Country:US
Practice Address - Phone:937-652-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH976190101YA0400X
OHE-2031101YM0800X
OHS-14556104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker