Provider Demographics
NPI:1467828657
Name:WOODS, BRENT CHRISTOPHER (MA, PLPC)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:CHRISTOPHER
Last Name:WOODS
Suffix:
Gender:M
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S VIENNA ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5829
Mailing Address - Country:US
Mailing Address - Phone:318-255-5020
Mailing Address - Fax:
Practice Address - Street 1:3501 PATRICK ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1717
Practice Address - Country:US
Practice Address - Phone:337-263-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6384101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600720479Medicaid