Provider Demographics
NPI:1952548471
Name:WOODRUFF, KRISTINA BURROW (MA, ATR-BC,LPAT)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:BURROW
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:MA, ATR-BC,LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PRESCOTT RDG
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-4726
Mailing Address - Country:US
Mailing Address - Phone:601-201-1515
Mailing Address - Fax:
Practice Address - Street 1:200 PARK CIRCLE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7628
Practice Address - Country:US
Practice Address - Phone:601-664-0455
Practice Address - Fax:601-664-1675
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPAT0006221700000X, 101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health