Provider Demographics
NPI:1477813020
Name:WOODY, DEITRA ANN (MS)
Entity Type:Individual
Prefix:
First Name:DEITRA
Middle Name:ANN
Last Name:WOODY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10920 NE 52ND ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-5217
Mailing Address - Country:US
Mailing Address - Phone:405-882-3231
Mailing Address - Fax:
Practice Address - Street 1:10920 NE 52ND ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-5217
Practice Address - Country:US
Practice Address - Phone:405-628-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor