Provider Demographics
NPI:1952772170
Name:WEST, VANESSA LEAH (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LEAH
Last Name:WEST
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 E 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349
Mailing Address - Country:US
Mailing Address - Phone:319-540-5643
Mailing Address - Fax:319-409-8120
Practice Address - Street 1:100 W 4TH STREET
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349
Practice Address - Country:US
Practice Address - Phone:319-540-5643
Practice Address - Fax:319-409-8120
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0221003Medicaid