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NPI Code Detail

MEDICARE: DR. JESSE MICHAEL WEST PH.D

MEDICARE: DR. JESSE MICHAEL WEST PH.D
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
1103TC0700XClinical Psychologist664SC

Other Identifiers

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

General Provider Information

NPI Number : 1609850825
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSE MICHAEL WEST PH.D
Provider Business Mailing Address
First Line : PO BOX 1090
Second Line :
City : HARTSVILLE
State : SC
Zip : 29551-1090
Country : US
Telephone Number : 843-857-0111
Fax Number : 843-857-0206
Provider Business Practice Location Address
First Line : 1268 S 4TH ST
Second Line :
City : HARTSVILLE
State : SC
Zip : 29550-0703
Country : US
Telephone Number : 843-332-3422
Fax Number : 843-332-3985
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2005
Last Update Date : 09/22/2021

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