Provider Demographics
NPI:1326388307
Name:WOODARD, SUSAN (LMFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 GREENSBORO ST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2883
Mailing Address - Country:US
Mailing Address - Phone:601-532-0096
Mailing Address - Fax:
Practice Address - Street 1:1801 CRANE RIDGE DR STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4902
Practice Address - Country:US
Practice Address - Phone:601-532-0096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0452106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist