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General NPI Number Information
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NPI Number | 1528953635
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Entity Type | Individual
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Provider Name | GINA PANZA WOODRUFF
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Gender | Female
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 1005 S MAYS ST
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City | ROUND ROCK
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State | TX
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Zip | 78664-6725
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Country | US
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Telephone | 512-661-4387
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Fax |
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Provider Business Mailing Address
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Address Line | 12004 LADRIDO LN
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City | AUSTIN
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State | TX
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Zip | 78727-6034
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Country | US
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Telephone | 512-554-7862
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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 | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 25-112
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 98046
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License Number State | TX
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