Provider Demographics
NPI:1902487374
Name:KOONS, WOODWYN WOODWYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WOODWYN
Middle Name:WOODWYN
Last Name:KOONS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 CUYAMA RD
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2416
Mailing Address - Country:US
Mailing Address - Phone:646-279-6391
Mailing Address - Fax:
Practice Address - Street 1:957 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-2015
Practice Address - Country:US
Practice Address - Phone:805-566-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32147103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty