MEDICARE: MRS. MARY LYNN WOOD MASTER OF EDUCATION

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1336561190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY LYNN WOOD MASTER OF EDUCATION

Provider Business Mailing Address
First Line	:	4011 ROLLING HILLS DR
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-9313
Country	:	US
Telephone Number	:	580-490-3112
Fax Number	:	580-490-3191

Provider Business Practice Location Address
First Line	:	4011 ROLLING HILLS DR
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-9313
Country	:	US
Telephone Number	:	580-490-3112
Fax Number	:	580-490-3191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/14/2014

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