Healthcare Provider Details

I. General information

NPI: 1326445610
Provider Name (Legal Business Name): PHILLIP WEST MSW, LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 LEONARD AVE
FAIRMONT WV
26554-3843
US

IV. Provider business mailing address

301 SCOTT AVE
MORGANTOWN WV
26508-8804
US

V. Phone/Fax

Practice location:
  • Phone: 304-366-7174
  • Fax: 304-366-7419
Mailing address:
  • Phone: 304-366-7174
  • Fax: 304-366-7419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBP00944528
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: