Healthcare Provider Details

I. General information

NPI: 1689812331
Provider Name (Legal Business Name): NATHANIEL ANTHONY WOODS JR. PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N EUCLID AVE APT 14
PASADENA CA
91101-1346
US

IV. Provider business mailing address

435 N EUCLID AVE APT 14
PASADENA CA
91101-1346
US

V. Phone/Fax

Practice location:
  • Phone: 510-815-2103
  • Fax:
Mailing address:
  • Phone: 510-815-2103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: