Healthcare Provider Details

I. General information

NPI: 1982957882
Provider Name (Legal Business Name): EVAN-MARIE WOODALL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 HORIZON RD STE C
HEATH TX
75032-2081
US

IV. Provider business mailing address

6730 HORIZON RD STE C
HEATH TX
75032-2081
US

V. Phone/Fax

Practice location:
  • Phone: 972-734-1985
  • Fax: 469-565-1274
Mailing address:
  • Phone: 972-734-1985
  • Fax: 469-565-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number67483
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: