Provider Demographics
NPI:1184017691
Name:WOODS, KATHY Q (MS)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:Q
Last Name:WOODS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157F E 4400 N
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:ID
Mailing Address - Zip Code:83316-5117
Mailing Address - Country:US
Mailing Address - Phone:208-420-5944
Mailing Address - Fax:
Practice Address - Street 1:1157F E 4400 N
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:ID
Practice Address - Zip Code:83316-5117
Practice Address - Country:US
Practice Address - Phone:208-420-5944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-07
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC 4462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional