Provider Demographics
NPI:1881644581
Name:LEE A WOODS LCSW PC
Entity Type:Organization
Organization Name:LEE A WOODS LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA
Authorized Official - Phone:928-472-8298
Mailing Address - Street 1:PO BOX 2752
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85547-2752
Mailing Address - Country:US
Mailing Address - Phone:928-472-8298
Mailing Address - Fax:928-472-7430
Practice Address - Street 1:616 S BEELINE HWY SUITE 108
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5380
Practice Address - Country:US
Practice Address - Phone:928-472-8298
Practice Address - Fax:928-472-7430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW0585261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ745440Medicaid
AZCSW585JMedicare ID - Type Unspecified
AZS13344Medicare UPIN
Z110574Medicare PIN