Provider Demographics
NPI:1689080947
Name:TOM WOODWARD LPC COUNSELOR LLC
Entity type:Organization
Organization Name:TOM WOODWARD LPC COUNSELOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:907-252-1839
Mailing Address - Street 1:35555 KENAI SPUR HWY
Mailing Address - Street 2:PMB 378
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7625
Mailing Address - Country:US
Mailing Address - Phone:907-252-1839
Mailing Address - Fax:
Practice Address - Street 1:238 CREST DR
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7425
Practice Address - Country:US
Practice Address - Phone:907-252-1839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK717OtherLICENSED PROFESSIONAL COUNSELOR