Provider Demographics
NPI:1295168706
Name:WEST, LERON GREGORY (MHR)
Entity type:Individual
Prefix:
First Name:LERON
Middle Name:GREGORY
Last Name:WEST
Suffix:
Gender:M
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27762
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74149-0762
Mailing Address - Country:US
Mailing Address - Phone:918-269-3013
Mailing Address - Fax:918-582-7612
Practice Address - Street 1:1115 W TECUMSEH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-2506
Practice Address - Country:US
Practice Address - Phone:918-599-7280
Practice Address - Fax:918-582-7612
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral