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General NPI Number Information
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NPI Number | 1871864165
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Entity Type | Individual
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Provider Name | MICHAEL LAVERNE WOODS JR. L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 123 22ND ST
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City | TOLEDO
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State | OH
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Zip | 43604-2706
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Country | US
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Telephone | 419-241-6191
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 CLOUGH ST APT 119
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City | BOWLING GREEN
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State | OH
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Zip | 43402-3309
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Country | US
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Telephone | 419-241-6191
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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 | C1000166
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License Number State | OH
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