MEDICARE: DANIEL WEST

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	101YP2500X	Professional Counselor		OK

General Provider Information

NPI Number	:	1346504115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL WEST

Provider Business Mailing Address
First Line	:	564 SPARROW RD
Second Line	:
City	:	VALLIANT
State	:	OK
Zip	:	74764-5472
Country	:	US
Telephone Number	:	580-933-5286
Fax Number	:

Provider Business Practice Location Address
First Line	:	564 SPARROW RD
Second Line	:
City	:	VALLIANT
State	:	OK
Zip	:	74764-9793
Country	:	US
Telephone Number	:	580-933-5286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	10/28/2014

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Directions to “ DANIEL WEST ” Practice Location

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