MEDICARE: MARTHA WOODLEY

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1225570765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA WOODLEY

Provider Business Mailing Address
First Line	:	706 BARROW PEAK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4291
Country	:	US
Telephone Number	:	210-209-7784
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-5656
Country	:	US
Telephone Number	:	210-313-3315
Fax Number	:

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

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/15/2016

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Directions to “ MARTHA WOODLEY ” Practice Location

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