Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP60167411 | WA |
Y | 101YM0800X | Mental Health Counselor | C2160 | OR |
NPI | 1013055748 |
---|---|
Provider Name | Timothy W West |
First Address | Vancouver, WA 98684-6055 |
Second Address | Vancouver, WA 98684-6055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 20/12/2021 |