Provider Demographics
NPI:1063246015
Name:WOODLAND PSYCHIATRY LLC
Entity type:Organization
Organization Name:WOODLAND PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODLAND
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:208-488-0958
Mailing Address - Street 1:144 E MARIE DR
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2128
Mailing Address - Country:US
Mailing Address - Phone:208-488-0958
Mailing Address - Fax:
Practice Address - Street 1:144 E MARIE DR
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2128
Practice Address - Country:US
Practice Address - Phone:208-488-0958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty