Provider Demographics
NPI:1417341173
Name:WOODSON, HARRELL (PHD)
Entity Type:Individual
Prefix:
First Name:HARRELL
Middle Name:
Last Name:WOODSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035
Mailing Address - Country:US
Mailing Address - Phone:713-275-5437
Mailing Address - Fax:
Practice Address - Street 1:12301 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035
Practice Address - Country:US
Practice Address - Phone:713-275-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32736103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist