Provider Demographics
NPI:1548517832
Name:WOODWARD, THERESA (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-1916
Mailing Address - Country:US
Mailing Address - Phone:307-399-9134
Mailing Address - Fax:
Practice Address - Street 1:440 NEVADA AVE
Practice Address - Street 2:
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-1916
Practice Address - Country:US
Practice Address - Phone:307-399-9134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional