Provider Demographics
NPI:1851638142
Name:WEST, REX DOUGLAS (MA)
Entity type:Individual
Prefix:
First Name:REX
Middle Name:DOUGLAS
Last Name:WEST
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4774 MCKINLEY DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1125
Mailing Address - Country:US
Mailing Address - Phone:303-335-7822
Mailing Address - Fax:
Practice Address - Street 1:4774 MCKINLEY DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1125
Practice Address - Country:US
Practice Address - Phone:303-335-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14112101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor