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NPI Code Detail

MEDICARE: BRANDY LYNELLE WOODS CDP

MEDICARE: BRANDY LYNELLE WOODS CDP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCP00006424WA

General Provider Information

NPI Number : 1194266890
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY LYNELLE WOODS CDP
Provider Business Mailing Address
First Line : 812 S WALNUT ST
Second Line :
City : SPOKANE
State : WA
Zip : 99204-3326
Country : US
Telephone Number : 509-624-3251
Fax Number : 509-624-4505
Provider Business Practice Location Address
First Line : 812 S WALNUT ST
Second Line :
City : SPOKANE
State : WA
Zip : 99204-3326
Country : US
Telephone Number : 509-624-3251
Fax Number : 509-624-4505
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2017
Last Update Date : 03/14/2017

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