1679825723 NPI number — MANDY ERIN WOODMAN LMFT

Table of content: MANDY ERIN WOODMAN LMFT (NPI 1679825723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679825723 NPI number — MANDY ERIN WOODMAN LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODMAN
Provider First Name:
MANDY
Provider Middle Name:
ERIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679825723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 384
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST RANCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95942-0384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-831-9279
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 PALM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-2626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-526-4037
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 51876 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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