Healthcare Provider Details

I. General information

NPI: 1851179394
Provider Name (Legal Business Name): HEATHER WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 17TH AVE
GREELEY CO
80631-9584
US

IV. Provider business mailing address

1300 N 17TH AVE
GREELEY CO
80631-9584
US

V. Phone/Fax

Practice location:
  • Phone: 970-347-2120
  • Fax:
Mailing address:
  • Phone: 970-347-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0023748
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: