Provider Demographics
NPI:1316988322
Name:WOOD, GARRETT GLEN (MA)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:GLEN
Last Name:WOOD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MEDICAL DRIVE
Mailing Address - Street 2:STE 205
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385
Mailing Address - Country:US
Mailing Address - Phone:636-332-5050
Mailing Address - Fax:636-327-4723
Practice Address - Street 1:600 MEDICAL DRIVE
Practice Address - Street 2:STE 205
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385
Practice Address - Country:US
Practice Address - Phone:636-332-5050
Practice Address - Fax:636-327-4723
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002460101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor