Doctor Name: | DR. HALON WOODROW BODDEN |
NPI Number: | 1205001211 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | SS577 |
Business Practice Address: | 610 Sportsman Park Dr Seffner, FL - 335844170 |
Business Phone Number: | 8136890365 |
Business Fax Number: | |
Mailing Address: | 610 Sportsman Park Dr, SEFFNER |
State: | FL |
Postal Code: | 335844170 |
Phone Number: | 8136890365 |
Fax Number: | |
NPI Enumeration Date: | 04/30/2008 |
NPI Last Update Date: | 04/30/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | SS577 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |