MEDICARE: JESSICA WEST LPCC

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	101YM0800X	Mental Health Counselor	CTB-2025-0317	NM
2	172V00000X	Community Health Worker
3	101YM0800X	Mental Health Counselor	MH20187	FL
4	101YM0800X	Mental Health Counselor	010117	NY

General Provider Information

NPI Number	:	1942832100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WEST LPCC

Provider Business Mailing Address
First Line	:	1734 SOPLO RD SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-4485
Country	:	US
Telephone Number	:	631-835-5864
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 OLD FARMINGDALE RD
Second Line	:
City	:	WEST BABYLON
State	:	NY
Zip	:	11704
Country	:	US
Telephone Number	:	631-835-5864
Fax Number	:

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

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	12/11/2025

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