Provider Demographics
NPI:1841052495
Name:WOOTEN, DARLENE
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:WOOTEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 TINY TOWN RD # 293
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-7202
Mailing Address - Country:US
Mailing Address - Phone:615-787-8775
Mailing Address - Fax:
Practice Address - Street 1:4980 W 59TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-1741
Practice Address - Country:US
Practice Address - Phone:323-412-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN138106H00000X
CA151400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty