Provider Demographics
NPI:1336561190
Name:WOOD, MARY LYNN (MASTER OF EDUCATION)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYNN
Last Name:WOOD
Suffix:
Gender:F
Credentials:MASTER OF EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4011 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-9313
Mailing Address - Country:US
Mailing Address - Phone:580-490-3112
Mailing Address - Fax:580-490-3191
Practice Address - Street 1:4011 ROLLING HILLS DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-9313
Practice Address - Country:US
Practice Address - Phone:580-490-3112
Practice Address - Fax:580-490-3191
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor