Provider Demographics
NPI:1780947283
Name:LAURA A WEST LPCC LLC
Entity type:Organization
Organization Name:LAURA A WEST LPCC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-749-4376
Mailing Address - Street 1:PO BOX 6385
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-6385
Mailing Address - Country:US
Mailing Address - Phone:575-749-4376
Mailing Address - Fax:575-904-9020
Practice Address - Street 1:100 S AVENUE A STE B7
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-5917
Practice Address - Country:US
Practice Address - Phone:575-749-4376
Practice Address - Fax:575-904-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0130471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty