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General NPI Number Information
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NPI Number | 1689558884
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Entity Type | Individual
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Provider Name | KELLY RAY WOODS AMFT
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Gender | Male
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Dates
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Enumeration Date | 08/01/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 614 GRAND AVE STE 203
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City | OAKLAND
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State | CA
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Zip | 94610-3554
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Country | US
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Telephone | 510-684-7606
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Fax |
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Provider Business Mailing Address
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Address Line | 224 TOLEDO CT
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City | VALLEJO
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State | CA
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Zip | 94591-6775
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Country | US
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Telephone | 510-684-7606
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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 | AMFT156385
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License Number State | CA
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