Provider Demographics
NPI:1770751372
Name:WOODY, LAUREN (LPE-I)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WOODY
Suffix:
Gender:F
Credentials:LPE-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-0783
Mailing Address - Country:US
Mailing Address - Phone:501-575-0510
Mailing Address - Fax:501-575-0550
Practice Address - Street 1:287 S BROADVIEW ST STE C-2
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9233
Practice Address - Country:US
Practice Address - Phone:501-575-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR09-02EI101YP2500X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396477824OtherGROUP NPI