Provider Demographics
NPI:1225180227
Name:WOOD, JESSE DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:DAVID
Last Name:WOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 NORFOLK ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4048
Mailing Address - Country:US
Mailing Address - Phone:713-526-6085
Mailing Address - Fax:713-522-7315
Practice Address - Street 1:2211 NORFOLK ST
Practice Address - Street 2:SUITE 500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4048
Practice Address - Country:US
Practice Address - Phone:713-526-6085
Practice Address - Fax:713-522-7315
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2954103TC0700X
TX6598103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool