Provider Demographics
NPI:1801809777
Name:WOOD, ARLIS GALE (PHD)
Entity type:Individual
Prefix:DR
First Name:ARLIS
Middle Name:GALE
Last Name:WOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6288
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-6288
Mailing Address - Country:US
Mailing Address - Phone:903-445-3780
Mailing Address - Fax:
Practice Address - Street 1:1201 W LOOP 281
Practice Address - Street 2:SUITE 501
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2937
Practice Address - Country:US
Practice Address - Phone:903-445-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32316103T00000X
OK330103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171974201Medicaid
TX171974201Medicaid