Healthcare Provider Details

I. General information

NPI: 1477577971
Provider Name (Legal Business Name): MICHAEL KENNETH WEST PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 2ND ST
SANFORD FL
32771-2172
US

IV. Provider business mailing address

801 E 2ND ST
SANFORD FL
32771-2172
US

V. Phone/Fax

Practice location:
  • Phone: 210-838-2108
  • Fax:
Mailing address:
  • Phone: 210-838-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: