1578878633 NPI number — MS. JEAN LOUISE WOOD MA,CM,C-PRSS

Table of content: MS. JEAN LOUISE WOOD MA,CM,C-PRSS (NPI 1578878633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578878633 NPI number — MS. JEAN LOUISE WOOD MA,CM,C-PRSS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
JEAN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA,CM,C-PRSS
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:
1578878633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3908 TERRY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEL CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73115-2836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-600-9786
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3908 TERRY WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEL CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73115-2836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-600-9786
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2010

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: 101YM0800X , with the licence number:  00013 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 10042011 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 251V00000X . This is a "CERTIFIED FAMILY MEDIATOR" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 101YM0800X . This is a "MEDICAID CERTIFIED PRSS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 376J00000X . This is a "IN HOME MANAGEMENT SKILLS TRAINING/COACHING" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 390200000X . This is a "PSYCHOLOGY PH.D. CANDIDATE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 163WC1600X . This is a "TRAINER FOR QPR GATEKEEPING" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 171M00000X . This is a "ODMHSAS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 372600000X . This is a "EARLY STAGE ALZHEIMERS AND ADULTS/YOUTH/ELDERLY WITH COGNITIVE LIMITATIONS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 146D00000X . This is a "CRISIS INTERVENTION ASSIST SUICIDE PREVENTION" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 373H00000X . This is a "HABILITATION AND INDEPENDENT LIVING SKILLS FOR DEVELOPMENTALLY DISABLED" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 376K00000X . This is a "GENERAL MEDICAL ELDERLY, YOUTH, ADULT TX PLAN SUPPORTIVE CARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 10042011 . This is a "BEHAVIORAL HEALTH REHABILITATION SPECIALIST" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 251V00000X . This is a "OKLAHOMA STATE BAR ASSOCIATION CERTIFIED CIVIL & EMPLOYMENT MEDIATOR" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 163WC0400X . This is a "ADULT BEHAVIORAL HEALTH AND INTENSIVE CASE MANAGEMENT" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 172V00000X . This is a "COMMUNITY HEALTH CARE WORKER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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