Provider Demographics
NPI:1720844129
Name:WOODCOCK, MAXWELL
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:
Last Name:WOODCOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-3148
Mailing Address - Country:US
Mailing Address - Phone:541-640-9310
Mailing Address - Fax:360-326-1978
Practice Address - Street 1:704 W HOOD AVE STE D
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1529
Practice Address - Country:US
Practice Address - Phone:541-640-9310
Practice Address - Fax:360-326-1978
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health