Provider Demographics
NPI:1073059879
Name:WOODERS, BRANDON K
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:K
Last Name:WOODERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3484 CEDARCREST AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2003
Mailing Address - Country:US
Mailing Address - Phone:225-478-9533
Mailing Address - Fax:225-478-9534
Practice Address - Street 1:3484 CEDARCREST AVE APT 405
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2003
Practice Address - Country:US
Practice Address - Phone:225-478-9533
Practice Address - Fax:225-478-9534
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor