Provider Demographics
NPI:1043670110
Name:WOODCOOK, TAVIA N (LCSW)
Entity Type:Individual
Prefix:
First Name:TAVIA
Middle Name:N
Last Name:WOODCOOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 FAIRVIEW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5795
Mailing Address - Country:US
Mailing Address - Phone:775-684-5018
Mailing Address - Fax:775-687-1181
Practice Address - Street 1:475 W HASKELL ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-6705
Practice Address - Country:US
Practice Address - Phone:775-623-6580
Practice Address - Fax:775-623-6584
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6282-S101YM0800X, 171M00000X
NV9658-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator