=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174227185
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FALLON MONIQUE WOODARD LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2023
-----------------------------------------------------
Last Update Date | 03/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 E SPRING CREEK PKWY APT 13301
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75074-3244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-803-7771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 E SPRING CREEK PKWY APT 13301
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75074-3244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-803-7771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 63335
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------