Healthcare Provider Details

I. General information

NPI: 1730323064
Provider Name (Legal Business Name): JOSHUA DANIEL WOOD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 JORDAN DR
MONTICELLO AR
71655-5714
US

IV. Provider business mailing address

PO BOX 509
DERMOTT AR
71638-0509
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-6246
  • Fax: 855-926-7383
Mailing address:
  • Phone: 870-538-5414
  • Fax: 870-538-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1210092
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: