Provider Demographics
NPI:1902913353
Name:WEST, PENNYE L (MED)
Entity type:Individual
Prefix:MRS
First Name:PENNYE
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 COUNTY ROAD 1835
Mailing Address - Street 2:
Mailing Address - City:YANTIS
Mailing Address - State:TX
Mailing Address - Zip Code:75497-4707
Mailing Address - Country:US
Mailing Address - Phone:903-383-3186
Mailing Address - Fax:903-383-2851
Practice Address - Street 1:947 COUNTY ROAD 1835
Practice Address - Street 2:
Practice Address - City:YANTIS
Practice Address - State:TX
Practice Address - Zip Code:75497-4707
Practice Address - Country:US
Practice Address - Phone:903-383-3186
Practice Address - Fax:903-383-2851
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3751LCOtherBLUE CROSS BLUE SHEILD