Provider Demographics
NPI:1144468604
Name:WEST, MARY ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:WEST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W 45TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2802
Mailing Address - Country:US
Mailing Address - Phone:512-451-2242
Mailing Address - Fax:512-454-9204
Practice Address - Street 1:810 W 45TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-2802
Practice Address - Country:US
Practice Address - Phone:512-451-2242
Practice Address - Fax:512-454-9204
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX414151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical