Provider Demographics
NPI:1225313604
Name:WOOD, STEPHEN JOHN (BCBA, LBA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOHN
Last Name:WOOD
Suffix:
Gender:M
Credentials:BCBA, LBA
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 1778
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40588-1778
Mailing Address - Country:US
Mailing Address - Phone:859-797-2763
Mailing Address - Fax:
Practice Address - Street 1:128 FAIRLAWN AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-3224
Practice Address - Country:US
Practice Address - Phone:859-797-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0004103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst