Doctor Name: | TERRY JO WOOD |
NPI Number: | 1295984771 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LADC |
License Number: | 302264 |
Business Practice Address: | 1000 8th St Se Detroit Lakes, MN - 565012819 |
Business Phone Number: | 2188470696 |
Business Fax Number: | 2188474198 |
Mailing Address: | 1000 8th St Se, DETROIT LAKES |
State: | MN |
Postal Code: | 565012819 |
Phone Number: | 2188470696 |
Fax Number: | 2188474198 |
NPI Enumeration Date: | 09/09/2008 |
NPI Last Update Date: | 09/09/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 302264 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |