Provider Demographics
NPI:1568898252
Name:WOOD, CORRIE (LIMHP)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 N 153RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-5176
Mailing Address - Country:US
Mailing Address - Phone:402-674-6957
Mailing Address - Fax:
Practice Address - Street 1:3803 N 153RD ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-5176
Practice Address - Country:US
Practice Address - Phone:402-674-6957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12322101YM0800X
171M00000X
NE3569101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator