Healthcare Provider Details

I. General information

NPI: 1295993863
Provider Name (Legal Business Name): JEFFREY CHRISTOPHER WOOD PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 CALIFORNIA AVE
BOULDER CITY NV
89005-2757
US

IV. Provider business mailing address

555 CALIFORNIA AVE
BOULDER CITY NV
89005-2757
US

V. Phone/Fax

Practice location:
  • Phone: 702-293-2231
  • Fax:
Mailing address:
  • Phone: 702-293-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number0699
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number0699
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number0699
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0699
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number0699
License Number StateNV
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0699
License Number StateNV
# 7
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0699
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: