Provider Demographics
NPI:1588671309
Name:WOOD, JENNIFER L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SWITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2003 RICKETY LN STE B
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1704
Mailing Address - Country:US
Mailing Address - Phone:903-283-8729
Mailing Address - Fax:888-454-9083
Practice Address - Street 1:2003 RICKETY LN STE B
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1704
Practice Address - Country:US
Practice Address - Phone:903-283-8729
Practice Address - Fax:888-454-9083
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20344101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEDICAID #OtherPENDING