Provider Demographics
NPI:1518326024
Name:WOODS, CLYDE JR
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:
Last Name:WOODS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8036 BAYOU FOUNTAIN AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820-8651
Mailing Address - Country:US
Mailing Address - Phone:504-390-6139
Mailing Address - Fax:
Practice Address - Street 1:8036 BAYOU FOUNTAIN AVE APT 3
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-8651
Practice Address - Country:US
Practice Address - Phone:504-390-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor