Provider Demographics
NPI:1144536715
Name:WOODS, D'JUAN CHANTRELL
Entity type:Individual
Prefix:
First Name:D'JUAN
Middle Name:CHANTRELL
Last Name:WOODS
Suffix:
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 1:8909 PLACID DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-4019
Mailing Address - Country:US
Mailing Address - Phone:405-464-1594
Mailing Address - Fax:
Practice Address - Street 1:700 NE 122ND ST
Practice Address - Street 2:704
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-8150
Practice Address - Country:US
Practice Address - Phone:405-464-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst