Provider Demographics
NPI:1326560053
Name:WOODS, CRISSY RAE (MA, RBT)
Entity Type:Individual
Prefix:
First Name:CRISSY
Middle Name:RAE
Last Name:WOODS
Suffix:
Gender:F
Credentials:MA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 CAMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8970
Mailing Address - Country:US
Mailing Address - Phone:270-789-7602
Mailing Address - Fax:
Practice Address - Street 1:121 CASEY ST STE A
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-6858
Practice Address - Country:US
Practice Address - Phone:270-465-7768
Practice Address - Fax:270-789-7602
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician