MEDICARE: COURTNEY WEST

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1386461051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY WEST

Provider Business Mailing Address
First Line	:	5717 COPPERFIELD TER
Second Line	:
City	:	PRINCE GEORGE
State	:	VA
Zip	:	23875-2354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 STURBRIDGE DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-3700
Country	:	US
Telephone Number	:	804-897-1753
Fax Number	:

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

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	09/24/2024

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Directions to “ COURTNEY WEST ” Practice Location

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