Provider Demographics
NPI:1952059131
Name:WOODHOUSE, MARK DUANE (MA, LCDC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DUANE
Last Name:WOODHOUSE
Suffix:
Gender:M
Credentials:MA, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8022 BORLAND CT
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-3179
Mailing Address - Country:US
Mailing Address - Phone:281-841-0442
Mailing Address - Fax:
Practice Address - Street 1:8022 BORLAND CT
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-3179
Practice Address - Country:US
Practice Address - Phone:281-841-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14579101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)