Provider Demographics
NPI:1598081861
Name:WOODS, DAVID RUSTY (MC;LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RUSTY
Last Name:WOODS
Suffix:
Gender:M
Credentials:MC;LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14240 N 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4511
Mailing Address - Country:US
Mailing Address - Phone:602-866-8850
Mailing Address - Fax:602-866-3430
Practice Address - Street 1:14240 N 43RD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4511
Practice Address - Country:US
Practice Address - Phone:602-866-8850
Practice Address - Fax:602-866-3430
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11834103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst