Basic Information
| Provider Information | |||||||||
| NPI: | 1255422374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODWARD | ||||||||
| FirstName: | W | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 S CREYTS RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489178234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173234099 | ||||||||
| FaxNumber: | 5173233334 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 S CREYTS RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489178234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173234099 | ||||||||
| FaxNumber: | 5173233334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 103T00000X | 6301003111 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.