Provider Demographics
NPI:1467885418
Name:WOODFORD, GERALD WILLIAM JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:WILLIAM
Last Name:WOODFORD
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 ENCHANTED FARM
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3506
Mailing Address - Country:US
Mailing Address - Phone:210-363-2141
Mailing Address - Fax:
Practice Address - Street 1:1222 N. MAIN
Practice Address - Street 2:SUITE 740-B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5711
Practice Address - Country:US
Practice Address - Phone:210-271-3630
Practice Address - Fax:210-271-9414
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional