Provider Demographics
NPI:1619327160
Name:WOODS, KEVIN II (MA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:WOODS
Suffix:II
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 W 590 N
Mailing Address - Street 2:
Mailing Address - City:VINEYARD
Mailing Address - State:UT
Mailing Address - Zip Code:84059-4812
Mailing Address - Country:US
Mailing Address - Phone:801-616-7798
Mailing Address - Fax:801-616-7798
Practice Address - Street 1:1633 W INNOVATION WAY FL 5
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4252
Practice Address - Country:US
Practice Address - Phone:801-616-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8746562-6004101YM0800X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional