Provider Demographics
NPI:1700078631
Name:WEST, LINDA L (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 BRIARWOOD DR STE 20
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-3040
Mailing Address - Country:US
Mailing Address - Phone:601-957-7670
Mailing Address - Fax:601-957-7640
Practice Address - Street 1:407 BRIARWOOD DR STE 209
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3036
Practice Address - Country:US
Practice Address - Phone:601-957-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC11271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00508083Medicaid