Provider Demographics
NPI:1043970114
Name:WOODHOUSE, LONELL (IS)
Entity Type:Individual
Prefix:
First Name:LONELL
Middle Name:
Last Name:WOODHOUSE
Suffix:
Gender:M
Credentials:IS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16732 CEDARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2845
Mailing Address - Country:US
Mailing Address - Phone:562-802-3558
Mailing Address - Fax:
Practice Address - Street 1:106 MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-4723
Practice Address - Country:US
Practice Address - Phone:562-731-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty