Provider Demographics
NPI:1548770548
Name:WOOD, JASON PAUL (LPCC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:PAUL
Last Name:WOOD
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 LIBRARY CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6327
Mailing Address - Country:US
Mailing Address - Phone:701-795-8550
Mailing Address - Fax:
Practice Address - Street 1:1726 S WASHINGTON ST STE 60
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6370
Practice Address - Country:US
Practice Address - Phone:701-795-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional