Provider Demographics
NPI:1760658017
Name:WOOD, JAMES (MFT)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 18TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3425
Mailing Address - Country:US
Mailing Address - Phone:310-838-2863
Mailing Address - Fax:310-453-9532
Practice Address - Street 1:3130 WILSHIRE BLVD
Practice Address - Street 2:SUITE 550
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2346
Practice Address - Country:US
Practice Address - Phone:310-838-2863
Practice Address - Fax:310-453-9532
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28825106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist