MEDICARE: JOHN O. WOOD PSYCHOLOGICAL SERVICES

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	251S00000X	Community/Behavioral Health Agency	01540	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346560869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN O. WOOD PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	1906 GREENWOOD DR
Second Line	:	SUITE B
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2430
Country	:	US
Telephone Number	:	573-778-3913
Fax Number	:	573-778-0925

Provider Business Practice Location Address
First Line	:	1906 GREENWOOD DR
Second Line	:	SUITE B
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2430
Country	:	US
Telephone Number	:	573-778-3913
Fax Number	:	573-778-0925

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN OWEN WOOD
Credential	:	PSY.D.
Telephone Number	:	573-778-3913

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	06/07/2010

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