Provider Demographics
NPI:1568892776
Name:PJ WOODS PS
Entity Type:Organization
Organization Name:PJ WOODS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:253-651-5109
Mailing Address - Street 1:3711 ENTRADA DR NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-3680
Mailing Address - Country:US
Mailing Address - Phone:253-651-5109
Mailing Address - Fax:
Practice Address - Street 1:1226 CARPENTER RD SE
Practice Address - Street 2:SUITE B3
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2493
Practice Address - Country:US
Practice Address - Phone:360-532-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003751103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty