Provider Demographics
NPI:1972648376
Name:WOOD, PATRICIA ANNE (MMH, LMFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:WOOD
Suffix:
Gender:F
Credentials:MMH, LMFT
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 704
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-0704
Mailing Address - Country:US
Mailing Address - Phone:906-482-5598
Mailing Address - Fax:906-482-5598
Practice Address - Street 1:222 SHELDEN AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-2134
Practice Address - Country:US
Practice Address - Phone:906-482-5598
Practice Address - Fax:906-482-5598
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006260106H00000X
CAM14416106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20814292OtherEIN