Healthcare Provider Details

I. General information

NPI: 1174380604
Provider Name (Legal Business Name): VANESSA WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 KILBOURNE ST STE G
BELLEVUE OH
44811-9431
US

IV. Provider business mailing address

PO BOX 202
BELLEVUE OH
44811-0202
US

V. Phone/Fax

Practice location:
  • Phone: 419-483-9411
  • Fax: 419-483-9247
Mailing address:
  • Phone: 194-483-9411
  • Fax: 419-483-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: