Provider Demographics
NPI:1043331572
Name:WOODS, KENNETH E (MA, LCSW)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:WOODS
Suffix:
Gender:M
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8129 DELMAR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3739
Mailing Address - Country:US
Mailing Address - Phone:314-490-4633
Mailing Address - Fax:
Practice Address - Street 1:8129 DELMAR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-3739
Practice Address - Country:US
Practice Address - Phone:314-490-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health