Provider Demographics
NPI:1497223176
Name:WOOD, SCOTT M (LMFT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:WOOD
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11665 AVENA PL STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2428
Mailing Address - Country:US
Mailing Address - Phone:858-449-1835
Mailing Address - Fax:
Practice Address - Street 1:11665 AVENA PL STE 206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2428
Practice Address - Country:US
Practice Address - Phone:858-449-1835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81808106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist