Healthcare Provider Details

I. General information

NPI: 1831596071
Provider Name (Legal Business Name): CLAIRE JULIA WOOD LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 PASEO DE LA CUMA
SANTA FE NM
87501-1221
US

IV. Provider business mailing address

1006 PASEO DE LA CUMA
SANTA FE NM
87501-1221
US

V. Phone/Fax

Practice location:
  • Phone: 505-692-9513
  • Fax:
Mailing address:
  • Phone: 505-692-9513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0189841
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: