Provider Demographics
NPI:1578878633
Name:WOOD, JEAN LOUISE (MA,CM,C-PRSS)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:LOUISE
Last Name:WOOD
Suffix:
Gender:F
Credentials:MA,CM,C-PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 TERRY WAY
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-2836
Mailing Address - Country:US
Mailing Address - Phone:405-600-9786
Mailing Address - Fax:
Practice Address - Street 1:3908 TERRY WAY
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-2836
Practice Address - Country:US
Practice Address - Phone:405-600-9786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK00013101YM0800X
OK10042011251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK251V00000XOtherCERTIFIED FAMILY MEDIATOR
OK101YM0800XOtherMEDICAID CERTIFIED PRSS
OK376J00000XOtherIN HOME MANAGEMENT SKILLS TRAINING/COACHING
AZ390200000XOtherPSYCHOLOGY PH.D. CANDIDATE
OK163WC1600XOtherTRAINER FOR QPR GATEKEEPING
OK171M00000XOtherODMHSAS
OK372600000XOtherEARLY STAGE ALZHEIMERS AND ADULTS/YOUTH/ELDERLY WITH COGNITIVE LIMITATIONS
OK146D00000XOtherCRISIS INTERVENTION ASSIST SUICIDE PREVENTION
OK373H00000XOtherHABILITATION AND INDEPENDENT LIVING SKILLS FOR DEVELOPMENTALLY DISABLED
OK376K00000XOtherGENERAL MEDICAL ELDERLY, YOUTH, ADULT TX PLAN SUPPORTIVE CARE
OK10042011OtherBEHAVIORAL HEALTH REHABILITATION SPECIALIST
OK251V00000XOtherOKLAHOMA STATE BAR ASSOCIATION CERTIFIED CIVIL & EMPLOYMENT MEDIATOR
OK163WC0400XOtherADULT BEHAVIORAL HEALTH AND INTENSIVE CASE MANAGEMENT
OK172V00000XOtherCOMMUNITY HEALTH CARE WORKER