| Doctor Name: | DR. MYRA DORENE WEST |
| NPI Number: | 1225224827 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | 071007264 |
| Business Practice Address: | 200 Lakewood Blvd Park Forest, IL - 604661718 |
| Business Phone Number: | 7084819799 |
| Business Fax Number: | 7084819951 |
| Mailing Address: | 200 Lakewood Blvd, PARK FOREST |
| State: | IL |
| Postal Code: | 604661718 |
| Phone Number: | 7084819799 |
| Fax Number: | 7084819951 |
| NPI Enumeration Date: | 09/18/2007 |
| NPI Last Update Date: | 04/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 071007264 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |