Provider Demographics
NPI:1922514553
Name:WOODS, MEGAN RAE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RAE
Last Name:WOODS
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 1:856 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3400
Mailing Address - Country:US
Mailing Address - Phone:318-429-6977
Mailing Address - Fax:318-227-6179
Practice Address - Street 1:856 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3400
Practice Address - Country:US
Practice Address - Phone:318-429-6977
Practice Address - Fax:318-227-6179
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1417252230Medicaid