Provider Demographics
NPI:1700395902
Name:RICHARDSON-WOOD, RACHEL LYNN
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:RICHARDSON-WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74352-5019
Mailing Address - Country:US
Mailing Address - Phone:918-931-2048
Mailing Address - Fax:
Practice Address - Street 1:1640 W KEETOOWAH ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3497
Practice Address - Country:US
Practice Address - Phone:918-708-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor