Provider Demographics
NPI:1922237437
Name:WOOD, J MICHAEL JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:MICHAEL
Last Name:WOOD
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8306 REYMERE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227
Mailing Address - Country:US
Mailing Address - Phone:501-225-2364
Mailing Address - Fax:
Practice Address - Street 1:8306 REYMERE DRIVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227
Practice Address - Country:US
Practice Address - Phone:501-225-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR07-25P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist