MEDICARE: KELLY WOODS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	202355	TX

General Provider Information

NPI Number	:	1174052310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY WOODS LMFT

Provider Business Mailing Address
First Line	:	9923 BURGUNDY LN
Second Line	:
City	:	WOODWAY
State	:	TX
Zip	:	76712-3101
Country	:	US
Telephone Number	:	254-523-7058
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 WASHINGTON AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76701-1019
Country	:	US
Telephone Number	:	254-523-7058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2017
Last Update Date	:	06/10/2017

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Directions to “ KELLY WOODS LMFT” Practice Location

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