Provider Demographics
NPI:1013388800
Name:WOODS, GARY LEE (MA, MA, JD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:WOODS
Suffix:
Gender:M
Credentials:MA, MA, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29237 BENT TREE DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2756
Mailing Address - Country:US
Mailing Address - Phone:949-463-1111
Mailing Address - Fax:
Practice Address - Street 1:12968 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5229
Practice Address - Country:US
Practice Address - Phone:951-242-7738
Practice Address - Fax:951-242-7733
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI2215101YP2500X
CAIMF87170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional