=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780947283
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURA A WEST LPCC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2012
-----------------------------------------------------
Last Update Date | 06/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 S AVENUE A STE B7
-----------------------------------------------------
City | PORTALES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88130-5917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-749-4376
-----------------------------------------------------
Fax | 575-904-9020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6385
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88102-6385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-749-4376
-----------------------------------------------------
Fax | 575-904-9020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | LAURA A WEST
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 575-749-4376
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0130471
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------