Healthcare Provider Details

I. General information

NPI: 1366307183
Provider Name (Legal Business Name): GWENDOLYN WEST LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S MILLER RD STE 110A
FAIRLAWN OH
44333-4180
US

IV. Provider business mailing address

123 S MILLER RD STE 110A
FAIRLAWN OH
44333-4180
US

V. Phone/Fax

Practice location:
  • Phone: 330-701-5797
  • Fax:
Mailing address:
  • Phone: 330-701-5797
  • Fax: 330-510-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2507728
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507728
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2507728
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: