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General NPI Number Information
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NPI Number | 1154749885
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Entity Type | Individual
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Provider Name | KELLY RYAN WOODS MSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 325 E PIONEER
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City | PUYALLUP
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State | WA
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Zip | 98372-3265
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Country | US
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Telephone | 253-697-8400
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Fax | 253-697-3730
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Provider Business Mailing Address
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Address Line | 18727 108TH AVE E
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City | PUYALLUP
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State | WA
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Zip | 98374-5673
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Country | US
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Telephone | 360-402-2717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CG60740446
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LH60604130
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC60340940
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60560942
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LW60560942
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License Number State | WA
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