Provider Demographics
NPI:1437743515
Name:WOOD COUNSELING CENTER, PLLC
Entity Type:Organization
Organization Name:WOOD COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:718-809-4836
Mailing Address - Street 1:805 LAKE ST UNIT 350
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1301
Mailing Address - Country:US
Mailing Address - Phone:718-809-4836
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 624
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7795
Practice Address - Country:US
Practice Address - Phone:718-809-4836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710543038Medicaid