Provider Demographics
NPI:1720224371
Name:WOODWARD, JUSTIN DAVID (MS MFT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:DAVID
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 RIVER ST
Mailing Address - Street 2:STE F
Mailing Address - City:BELLEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53508-9188
Mailing Address - Country:US
Mailing Address - Phone:608-445-3452
Mailing Address - Fax:608-424-9099
Practice Address - Street 1:619 RIVER ST
Practice Address - Street 2:STE. F
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9188
Practice Address - Country:US
Practice Address - Phone:608-445-3452
Practice Address - Fax:608-424-9099
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist