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General NPI Number Information
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NPI Number | 1386814051
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Entity Type | Individual
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Provider Name | MARY ROBIN WOOD PH.D., L.M.H.C.
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Gender | Female
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Dates
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Enumeration Date | 03/09/2008
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 227 N DIXIE WAY STE 335
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City | SOUTH BEND
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State | IN
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Zip | 46637-3385
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Country | US
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Telephone | 574-220-1298
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Fax | 574-472-1282
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Provider Business Mailing Address
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Address Line | 620 W ANGELA BLVD
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City | SOUTH BEND
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State | IN
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Zip | 46617-1008
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Country | US
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Telephone | 574-220-1298
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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 | 39001959A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 20042170A
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License Number State | IN
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