Provider Demographics
NPI:1881137503
Name:WOODS, COLLIS JR
Entity type:Individual
Prefix:
First Name:COLLIS
Middle Name:
Last Name:WOODS
Suffix:JR
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 1:640 S SPLIT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BENNETT
Mailing Address - State:CO
Mailing Address - Zip Code:80102-8708
Mailing Address - Country:US
Mailing Address - Phone:301-730-2374
Mailing Address - Fax:
Practice Address - Street 1:640 S SPLIT ROCK RD
Practice Address - Street 2:
Practice Address - City:BENNETT
Practice Address - State:CO
Practice Address - Zip Code:80102-8708
Practice Address - Country:US
Practice Address - Phone:301-730-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONCL.0106206101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health