Provider Demographics
NPI:1780227017
Name:WOODWARD, AHLSA LIGHT
Entity Type:Individual
Prefix:
First Name:AHLSA
Middle Name:LIGHT
Last Name:WOODWARD
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 1:710 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2412
Mailing Address - Country:US
Mailing Address - Phone:970-252-3200
Mailing Address - Fax:970-641-2949
Practice Address - Street 1:710 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2412
Practice Address - Country:US
Practice Address - Phone:970-252-3200
Practice Address - Fax:970-641-2949
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health