MEDICARE: MRS. CLARETTA DORIS WOODS

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	101YP1600X	Pastoral Counselor	MC-2016-142	OK

General Provider Information

NPI Number	:	1588434930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CLARETTA DORIS WOODS

Provider Business Mailing Address
First Line	:	1009 MEADOWVALE DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7032
Country	:	US
Telephone Number	:	405-414-9396
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 MEADOWVALE DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7032
Country	:	US
Telephone Number	:	405-414-9396
Fax Number	:

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

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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