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General NPI Number Information
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NPI Number | 1174740252
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Entity Type | Individual
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Provider Name | MICHAEL WOODIN PHD
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 1130 N J ST
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City | RICHMOND
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State | IN
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Zip | 47374-1913
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Country | US
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Telephone | 765-983-3298
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Fax | 765-983-7970
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Provider Business Mailing Address
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Address Line | 1100 REID PARKWAY MEDICAL STAFF SERVICES
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City | RICHMOND
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State | IN
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Zip | 47374
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Country | US
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Telephone | 765-935-8802
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Fax | 765-983-3219
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20042068A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | P.07823
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 20042068B
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License Number State | IN
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