Provider Demographics
NPI:1548343023
Name:WEST, ELIZABETH JEAN (MA, LMFT, LP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JEAN
Last Name:WEST
Suffix:
Gender:F
Credentials:MA, LMFT, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DOVE ST.
Mailing Address - Street 2:SUITE 295
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-975-1864
Mailing Address - Fax:
Practice Address - Street 1:901 DOVE ST.
Practice Address - Street 2:SUITE 295
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-975-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28806103T00000X
CAMFC28806 & LPC78103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103T00000XBehavioral Health & Social Service ProvidersPsychologist