Provider Demographics
NPI:1679825723
Name:WOODMAN, MANDY ERIN (LMFT)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:ERIN
Last Name:WOODMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:FOREST RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:95942-0384
Mailing Address - Country:US
Mailing Address - Phone:909-831-9279
Mailing Address - Fax:
Practice Address - Street 1:900 PALM ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2626
Practice Address - Country:US
Practice Address - Phone:530-526-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51876106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist