Provider Demographics
NPI:1568049369
Name:WOOD, ANGELYN (MS)
Entity Type:Individual
Prefix:
First Name:ANGELYN
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:SCALLION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:575 S ROYAL ST STE 24
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-7307
Mailing Address - Country:US
Mailing Address - Phone:731-215-0502
Mailing Address - Fax:731-345-4086
Practice Address - Street 1:575 S ROYAL ST STE 24
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-7307
Practice Address - Country:US
Practice Address - Phone:731-215-0502
Practice Address - Fax:731-345-4086
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5369OtherSTATE OF TN