MEDICARE: GWENDOLYN WEST LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C.2507728	OH
2	101YM0800X	Mental Health Counselor	C.2507728	OH
3	101Y00000X	Counselor	C.2507728	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366307183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN WEST LPC

Provider Business Mailing Address
First Line	:	123 S MILLER RD STE 110A
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-4180
Country	:	US
Telephone Number	:	330-701-5797
Fax Number	:	330-510-5900

Provider Business Practice Location Address
First Line	:	123 S MILLER RD STE 110A
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-4180
Country	:	US
Telephone Number	:	330-701-5797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	05/26/2026

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Directions to “ GWENDOLYN WEST LPC” Practice Location

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