Basic Information
| Provider Information | |||||||||
| NPI: | 1720115215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LCSW,LCDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 GLENDALE PL | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787044432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124472133 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5425A BURNET RD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787561627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124547337 | ||||||||
| FaxNumber: | 5124518729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 07/31/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 16110 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 3067 | TX | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.