Provider Demographics
NPI:1932132990
Name:WOODY, LOU RAE (LMFT , LPCC)
Entity Type:Individual
Prefix:
First Name:LOU RAE
Middle Name:
Last Name:WOODY
Suffix:
Gender:F
Credentials:LMFT , LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28565
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-8565
Mailing Address - Country:US
Mailing Address - Phone:505-992-3129
Mailing Address - Fax:505-820-1209
Practice Address - Street 1:820 PASEO DE PERALTA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2233
Practice Address - Country:US
Practice Address - Phone:505-992-3129
Practice Address - Fax:505-820-1209
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1324101YP2500X
NM1325106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70814Medicaid