Provider Demographics
NPI:1679783773
Name:WOODS, BEVERLY JO (MA)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JO
Last Name:WOODS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-4907
Mailing Address - Country:US
Mailing Address - Phone:713-526-9578
Mailing Address - Fax:
Practice Address - Street 1:4507 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4907
Practice Address - Country:US
Practice Address - Phone:713-526-9578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21783174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist