Provider Demographics
NPI:1003328394
Name:WOOD, KELSEY LYNN
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:ANSON
Mailing Address - State:TX
Mailing Address - Zip Code:79501-6117
Mailing Address - Country:US
Mailing Address - Phone:903-426-4866
Mailing Address - Fax:
Practice Address - Street 1:1715 AVENUE L
Practice Address - Street 2:
Practice Address - City:ANSON
Practice Address - State:TX
Practice Address - Zip Code:79501-6117
Practice Address - Country:US
Practice Address - Phone:903-426-4866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician