Provider Demographics
NPI:1710528526
Name:WOODSON, EMMA HARVIN
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:HARVIN
Last Name:WOODSON
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 1:3535 FIREWHEEL DR STE F
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7719
Mailing Address - Country:US
Mailing Address - Phone:214-499-0396
Mailing Address - Fax:
Practice Address - Street 1:3535 FIREWHEEL DR STE F
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7719
Practice Address - Country:US
Practice Address - Phone:214-499-0396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19-85475106S00000X
TX91107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician