Healthcare Provider Details

I. General information

NPI: 1447754486
Provider Name (Legal Business Name): YOLANDA WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 E JEFFERSON AVE
BASTROP LA
71220
US

IV. Provider business mailing address

644 E JEFFERSON AVE
BASTROP LA
71220-4619
US

V. Phone/Fax

Practice location:
  • Phone: 318-239-3862
  • Fax: 318-239-3867
Mailing address:
  • Phone: 318-239-3862
  • Fax: 318-239-3867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: