Provider Demographics
NPI:1265536734
Name:WOOD, AUSTIN (LMFT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E CENTER ST
Mailing Address - Street 2:#102
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4664
Mailing Address - Country:US
Mailing Address - Phone:435-363-7317
Mailing Address - Fax:
Practice Address - Street 1:60 E CENTER ST
Practice Address - Street 2:#102
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4664
Practice Address - Country:US
Practice Address - Phone:435-363-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5190885-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist