MEDICARE: DESIREE WOODSIDE LPC

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	101YP2500X	Professional Counselor	320030	TX

General Provider Information

NPI Number	:	1568992212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE WOODSIDE LPC

Provider Business Mailing Address
First Line	:	9284 HUNTINGTON SQ
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-4366
Country	:	US
Telephone Number	:	817-771-9016
Fax Number	:

Provider Business Practice Location Address
First Line	:	9284 HUNTINGTON SQ
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-4366
Country	:	US
Telephone Number	:	817-771-9016
Fax Number	:

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

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	07/21/2022

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Directions to “ DESIREE WOODSIDE LPC” Practice Location

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