Provider Demographics
NPI:1679913891
Name:WEST, KEELY DYANE (NCC,LPC)
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:DYANE
Last Name:WEST
Suffix:
Gender:F
Credentials:NCC,LPC
Other - Prefix:
Other - First Name:KEELY
Other - Middle Name:DYANE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCC,LPC
Mailing Address - Street 1:1901 DUTTON DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7573
Mailing Address - Country:US
Mailing Address - Phone:512-396-7695
Mailing Address - Fax:512-396-7633
Practice Address - Street 1:1901 DUTTON DR
Practice Address - Street 2:SUITE E
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7573
Practice Address - Country:US
Practice Address - Phone:512-396-7695
Practice Address - Fax:512-396-7633
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61503101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065337001Medicaid