Healthcare Provider Details

I. General information

NPI: 1942832100
Provider Name (Legal Business Name): JESSICA WEST LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 OLD FARMINGDALE RD
WEST BABYLON NY
11704
US

IV. Provider business mailing address

1734 SOPLO RD SE
ALBUQUERQUE NM
87123-4485
US

V. Phone/Fax

Practice location:
  • Phone: 631-835-5864
  • Fax:
Mailing address:
  • Phone: 631-835-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0317
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20187
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: