Provider Demographics
NPI:1003315698
Name:WOODS, AUTUMN GAEA (MA, AMFT)
Entity Type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:GAEA
Last Name:WOODS
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:MS
Other - First Name:AUTUMN
Other - Middle Name:GAEA
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GAEA WOODS
Mailing Address - Street 1:2841 PARTRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2934
Mailing Address - Country:US
Mailing Address - Phone:213-399-9507
Mailing Address - Fax:
Practice Address - Street 1:4620 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5408
Practice Address - Country:US
Practice Address - Phone:818-245-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist