Healthcare Provider Details

I. General information

NPI: 1336622059
Provider Name (Legal Business Name): AMY WEST LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date: 10/11/2018
Reactivation Date: 10/19/2018

III. Provider practice location address

8382 MONTGOMERY RUN RD APT C
ELLICOTT CITY MD
21043-7471
US

IV. Provider business mailing address

8382 MONTGOMERY RUN RD APT C
ELLICOTT CITY MD
21043-7471
US

V. Phone/Fax

Practice location:
  • Phone: 443-980-9012
  • Fax:
Mailing address:
  • Phone: 443-980-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC8755
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: