Provider Demographics
NPI:1700288784
Name:DR. JEFFREY C. WOOD, PSY.D., PLLC
Entity Type:Organization
Organization Name:DR. JEFFREY C. WOOD, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:702-293-2231
Mailing Address - Street 1:555 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2757
Mailing Address - Country:US
Mailing Address - Phone:702-293-2231
Mailing Address - Fax:
Practice Address - Street 1:555 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2757
Practice Address - Country:US
Practice Address - Phone:702-293-2231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-21
Last Update Date:2014-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0699261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)