Basic Information
| Provider Information | |||||||||
| NPI: | 1144560327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEST | ||||||||
| FirstName: | CHAD | ||||||||
| MiddleName: | EVERET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 W VINE ST | ||||||||
| Address2: | |||||||||
| City: | SHERIDAN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721502148 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5918 LEE AVE | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722053326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016632199 | ||||||||
| FaxNumber: | 5016632234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2013 | ||||||||
| LastUpdateDate: | 02/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A1302023 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.