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General NPI Number Information
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NPI Number | 1366820839
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Entity Type | Individual
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Provider Name | DERRICK LAMONT WOODBURY LPC
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Gender | Male
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 10212 E 41ST ST
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City | TULSA
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State | OK
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Zip | 74146-3703
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Country | US
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Telephone | 918-970-0028
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Fax | 918-960-7308
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Provider Business Mailing Address
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Address Line | 5928 E 7TH ST
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City | TULSA
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State | OK
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Zip | 74112-2913
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Country | US
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Telephone | 918-970-0028
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Fax | 918-960-7308
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P2212014
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC013870
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5604
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5604
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License Number State | OK
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