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NPI Code Detail

MEDICARE: MR. LARRY ALBERT WOODWARD MFTI

MEDICARE: MR. LARRY ALBERT WOODWARD MFTI
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1669693123
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LARRY ALBERT WOODWARD MFTI
Provider Business Mailing Address
First Line : 6321 33RD AVE
Second Line :
City : SACRAMENTO
State : CA
Zip : 95824-1901
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5240 JACKSON ST
Second Line :
City : NORTH HIGHLANDS
State : CA
Zip : 95660-5003
Country : US
Telephone Number : 916-338-1001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 07/08/2007

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