MEDICARE: CAROLE WEST PHD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301014339	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MI4555	OTHER	MI	PTAN

General Provider Information

NPI Number	:	1144513847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLE WEST PHD, PLLC

Provider Business Mailing Address
First Line	:	1530 N DEARBORN PKWY APT 20S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-1406
Country	:	US
Telephone Number	:	248-894-6390
Fax Number	:	248-592-7053

Provider Business Practice Location Address
First Line	:	1530 N DEARBORN PKWY APT 20S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-1406
Country	:	US
Telephone Number	:	248-987-8555
Fax Number	:	248-592-7053

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	CAROLE E. WEST
Credential	:
Telephone Number	:	248-987-8555

Provider Enumeration Date	:	05/27/2011
Last Update Date	:	01/05/2026

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