Basic Information
| Provider Information | |||||||||
| NPI: | 1700345832 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | LMSW, LCDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2112 UPPER ELGIN RIVER RD | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786215732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124233377 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5524 BEE CAVES ROAD, SUITE K4 | ||||||||
| Address2: | |||||||||
| City: | WEST LAKE HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787467874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127100551 | ||||||||
| FaxNumber: | 5127176337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2019 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 61474 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.