Provider Demographics
NPI:1376829283
Name:WEST, KATHRYN SUE (LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SUE
Last Name:WEST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 6 BOX 45
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-9503
Mailing Address - Country:US
Mailing Address - Phone:918-629-6075
Mailing Address - Fax:
Practice Address - Street 1:RR 6 BOX 45
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-9503
Practice Address - Country:US
Practice Address - Phone:918-629-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional