Provider Demographics
NPI:1295883353
Name:WOOD, JAMES MERRILL (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MERRILL
Last Name:WOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34390 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1434
Mailing Address - Country:US
Mailing Address - Phone:248-426-0076
Mailing Address - Fax:
Practice Address - Street 1:23629 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48335-3568
Practice Address - Country:US
Practice Address - Phone:248-474-9907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008510103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist