Provider Demographics
NPI:1659019107
Name:WOODY, JENNIFER K (LPMHP, LPADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:WOODY
Suffix:
Gender:F
Credentials:LPMHP, LPADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 S TOPAZ WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4474
Mailing Address - Country:US
Mailing Address - Phone:208-605-7070
Mailing Address - Fax:833-561-2438
Practice Address - Street 1:7215 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3574
Practice Address - Country:US
Practice Address - Phone:531-999-7120
Practice Address - Fax:531-329-2701
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1940101YA0400X
NELPMHP-12848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)