Provider Demographics
NPI:1508253915
Name:WOODARD, DENISE EL VONNE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:EL VONNE
Last Name:WOODARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 W WARM SPRINGS RD
Mailing Address - Street 2:911
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-4574
Mailing Address - Country:US
Mailing Address - Phone:702-245-6710
Mailing Address - Fax:
Practice Address - Street 1:3001 W WARM SPRINGS RD
Practice Address - Street 2:911
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-4574
Practice Address - Country:US
Practice Address - Phone:702-245-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1982975009Medicaid