Healthcare Provider Details

I. General information

NPI: 1336016716
Provider Name (Legal Business Name): LISA WOODS PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 PONDEROSA RD
SHINGLE SPRINGS CA
95682-9460
US

IV. Provider business mailing address

4675 MISSOURI FLAT RD
PLACERVILLE CA
95667-6816
US

V. Phone/Fax

Practice location:
  • Phone: 530-677-2281
  • Fax:
Mailing address:
  • Phone: 530-677-2281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: