Provider Demographics
NPI:1730872326
Name:WOODWARD, SETH JAMES
Entity type:Individual
Prefix:MR
First Name:SETH
Middle Name:JAMES
Last Name:WOODWARD
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 1:12443 LEWIS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4650
Mailing Address - Country:US
Mailing Address - Phone:714-748-4440
Mailing Address - Fax:
Practice Address - Street 1:1265 N CHRISDEN ST APT P207
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2264
Practice Address - Country:US
Practice Address - Phone:714-818-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician