Provider Demographics
NPI:1750544524
Name:WEST, CONNIE MARIE (MS LPCI)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:MARIE
Last Name:WEST
Suffix:
Gender:F
Credentials:MS LPCI
Other - Prefix:MISS
Other - First Name:CONNIE
Other - Middle Name:M
Other - Last Name:HOBDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LPCI
Mailing Address - Street 1:3001 HAMILTON CHURCH RD
Mailing Address - Street 2:UNIT 307
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-7401
Mailing Address - Country:US
Mailing Address - Phone:615-867-6000
Mailing Address - Fax:
Practice Address - Street 1:3400 LEBANON ROAD
Practice Address - Street 2:ALVIN C YORK CAMPUS DEPARTMENT OF VETERAN AFFAIRS
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1237
Practice Address - Country:US
Practice Address - Phone:615-867-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX60284OtherSTATE OF TEXAS TEMP COUNSELOR LICENSE