Provider Demographics
NPI:1972642767
Name:WOODEN, HOWARD (PHD HSSP)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:WOODEN
Suffix:
Gender:M
Credentials:PHD HSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WABASH AVE STE 212
Mailing Address - Street 2:PO BOX 98
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-3276
Mailing Address - Country:US
Mailing Address - Phone:812-234-4642
Mailing Address - Fax:812-234-7314
Practice Address - Street 1:400 WABASH AVE STE 212
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3276
Practice Address - Country:US
Practice Address - Phone:812-234-4642
Practice Address - Fax:812-234-7314
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20090127A103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10025192AMedicaid
IN10025192AMedicaid