=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336446145
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST NEUROPSYCHOLOGY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2011
-----------------------------------------------------
Last Update Date | 02/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 PRINCETON AVE SW PROFESSIONAL OFFICE BUILDING I, SUITE 205
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35211-1310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-453-9888
-----------------------------------------------------
Fax | 205-453-0003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 PRINCETON AVE SW PROFESSIONAL OFFICE BUILDING I, SUITE 205
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35211-1310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-453-9888
-----------------------------------------------------
Fax | 205-453-0003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICAL NEUROPSYCHOLOGIST
-----------------------------------------------------
Name | DR. DELISA ARLINDA WEST
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 205-453-9888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 1342
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------