Provider Demographics
NPI:1205815271
Name:WOODARD, MARTIN T (ACSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:T
Last Name:WOODARD
Suffix:
Gender:M
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8747
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77249-8747
Mailing Address - Country:US
Mailing Address - Phone:713-695-3742
Mailing Address - Fax:713-695-3742
Practice Address - Street 1:1310 FRAWLEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-3428
Practice Address - Country:US
Practice Address - Phone:713-695-3742
Practice Address - Fax:713-695-3742
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DO266Medicare ID - Type Unspecified
TXQ31980Medicare UPIN