Provider Demographics
NPI:1306956230
Name:WEST, DEBORAH (MA, LPC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78403-0783
Mailing Address - Country:US
Mailing Address - Phone:361-883-1219
Mailing Address - Fax:361-887-1080
Practice Address - Street 1:101 N SHORELINE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2825
Practice Address - Country:US
Practice Address - Phone:361-883-1219
Practice Address - Fax:361-887-1080
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163169902Medicaid