Provider Demographics
NPI:1679871131
Name:WOOD, EMMA JANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:JANE
Last Name:WOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BUCKINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-4204
Mailing Address - Country:US
Mailing Address - Phone:254-722-1605
Mailing Address - Fax:
Practice Address - Street 1:2320 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-1276
Practice Address - Country:US
Practice Address - Phone:254-722-1605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2016-06-27
Deactivation Date:2012-03-30
Deactivation Code:
Reactivation Date:2012-05-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist