Provider Demographics
NPI:1912031576
Name:WEST, SUSAN E (MFC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:WEST
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23842 KARA BAY
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-4410
Mailing Address - Country:US
Mailing Address - Phone:949-496-7370
Mailing Address - Fax:949-218-5526
Practice Address - Street 1:2900 BRISTOL ST
Practice Address - Street 2:STE. G-201
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5981
Practice Address - Country:US
Practice Address - Phone:949-218-5526
Practice Address - Fax:949-218-5526
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 23267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health