=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316589682
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAIL A WOOD LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2019
-----------------------------------------------------
Last Update Date | 12/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 N K AVE STE 2
-----------------------------------------------------
City | VINTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52349-2506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-929-3409
-----------------------------------------------------
Fax | 319-409-6159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 N K AVE STE 2
-----------------------------------------------------
City | VINTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52349-2506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-929-3409
-----------------------------------------------------
Fax | 319-409-6159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 096008
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------