Provider Demographics
NPI:1598208159
Name:WOOD, TERILYN
Entity Type:Individual
Prefix:
First Name:TERILYN
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 AIRPORT RD TRLR B2
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8109
Mailing Address - Country:US
Mailing Address - Phone:530-315-1852
Mailing Address - Fax:
Practice Address - Street 1:3300 AIRPORT RD TRLR B2
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8109
Practice Address - Country:US
Practice Address - Phone:530-315-1852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician