Provider Demographics
NPI:1700151404
Name:WOODY, STANLEY A (LMHC)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:A
Last Name:WOODY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 GOETHALS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3534
Mailing Address - Country:US
Mailing Address - Phone:509-222-0120
Mailing Address - Fax:
Practice Address - Street 1:805 GOETHALS DR STE 1
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3534
Practice Address - Country:US
Practice Address - Phone:509-222-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 00005829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA453802427Medicaid
WA453802427OtherMEDICARE