Healthcare Provider Details

I. General information

NPI: 1013055748
Provider Name (Legal Business Name): TIMOTHY W WEST MA, LPC, CDP, CADC 3
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12607 SE MILL PLAIN BLVD
VANCOUVER WA
98684-6055
US

IV. Provider business mailing address

12607 SE MILL PLAIN BLVD
VANCOUVER WA
98684-6055
US

V. Phone/Fax

Practice location:
  • Phone: 360-891-6275
  • Fax:
Mailing address:
  • Phone: 503-970-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60167411
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC2160
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: