Provider Demographics
NPI:1366778797
Name:WEST, JOHN LEE (PHD, MC, LPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LEE
Last Name:WEST
Suffix:
Gender:M
Credentials:PHD, MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S WILCOX ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1933
Mailing Address - Country:US
Mailing Address - Phone:719-290-8790
Mailing Address - Fax:303-639-5240
Practice Address - Street 1:201 S WILCOX ST STE 102
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1933
Practice Address - Country:US
Practice Address - Phone:719-290-8790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4233101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000149241Medicaid