Provider Demographics
NPI:1205977568
Name:LM WOOD MARRIAGE AND FAMILY THERAPY INC
Entity type:Organization
Organization Name:LM WOOD MARRIAGE AND FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:909-860-8141
Mailing Address - Street 1:24254 BRECKENRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4366
Mailing Address - Country:US
Mailing Address - Phone:909-860-8141
Mailing Address - Fax:
Practice Address - Street 1:24254 BRECKENRIDGE CT
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4366
Practice Address - Country:US
Practice Address - Phone:909-860-8141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC-43677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty