Provider Demographics
NPI:1417724030
Name:WOOD, BRADEN ALEXANDER
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:ALEXANDER
Last Name:WOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 JD TOWLES DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-8654
Mailing Address - Country:US
Mailing Address - Phone:682-900-1444
Mailing Address - Fax:432-322-4597
Practice Address - Street 1:161 JD TOWLES DR
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-8654
Practice Address - Country:US
Practice Address - Phone:682-900-1444
Practice Address - Fax:432-322-4597
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician