Provider Demographics
NPI:1063694123
Name:WEST, SHEALAH M (LSCSW)
Entity type:Individual
Prefix:
First Name:SHEALAH
Middle Name:M
Last Name:WEST
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:SHEALAH
Other - Middle Name:M
Other - Last Name:GULICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:423 N MCLEAN BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5964
Mailing Address - Country:US
Mailing Address - Phone:316-288-1254
Mailing Address - Fax:316-221-7154
Practice Address - Street 1:423 N MCLEAN BLVD STE 203
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5964
Practice Address - Country:US
Practice Address - Phone:316-288-1254
Practice Address - Fax:316-221-7154
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200533030CMedicaid