MEDICARE: MR. ALLEN TATE WOOD BA LADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0682	NH

General Provider Information

NPI Number	:	1336489152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALLEN TATE WOOD BA LADC

Provider Business Mailing Address
First Line	:	97 N MAIN ST
Second Line	:
City	:	ROCHESTER
State	:	NH
Zip	:	03867-1924
Country	:	US
Telephone Number	:	603-380-1312
Fax Number	:

Provider Business Practice Location Address
First Line	:	97 N MAIN ST
Second Line	:
City	:	ROCHESTER
State	:	NH
Zip	:	03867-1924
Country	:	US
Telephone Number	:	603-380-1312
Fax Number	:

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

Provider Enumeration Date	:	02/15/2013
Last Update Date	:	02/15/2013

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