Provider Demographics
NPI:1235625609
Name:WOOD, VICTORIA LYNNE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNNE
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16835 DEER CREEK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-4895
Mailing Address - Country:US
Mailing Address - Phone:281-290-4411
Mailing Address - Fax:832-916-2283
Practice Address - Street 1:16835 DEER CREEK DR STE 200
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4895
Practice Address - Country:US
Practice Address - Phone:281-290-4411
Practice Address - Fax:832-916-2283
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2791106E00000X
TXBACB371382106S00000X
TX3078103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician