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General NPI Number Information
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NPI Number | 1689080947
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Entity Type | Organization
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Legal Business Name | TOM WOODWARD LPC COUNSELOR LLC
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 238 CREST DR
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City | SOLDOTNA
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State | AK
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Zip | 99669-7425
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Country | US
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Telephone | 907-252-1839
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Fax |
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Provider Business Mailing Address
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Address Line | 35555 KENAI SPUR HWY PMB 378
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City | SOLDOTNA
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State | AK
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Zip | 99669-7625
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Country | US
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Telephone | 907-252-1839
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. THOMAS G WOODWARD
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Credential | LPC
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Telephone | 907-252-1839
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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 | 717
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License Number State | AK
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