Provider Demographics
NPI:1912672288
Name:WEST, RANDY SILAS JR (MA LPC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:SILAS
Last Name:WEST
Suffix:JR
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SPRING CREEK ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-1030
Mailing Address - Country:US
Mailing Address - Phone:402-990-4979
Mailing Address - Fax:
Practice Address - Street 1:117 SPRING CREEK ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-1030
Practice Address - Country:US
Practice Address - Phone:402-502-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4977101YM0800X
TX85924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health