Provider Demographics
NPI:1528665148
Name:WOOD, KATHRYN ROSE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 POWELL PL # 1095
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3622
Mailing Address - Country:US
Mailing Address - Phone:615-829-6496
Mailing Address - Fax:
Practice Address - Street 1:100 POWELL PL # 1095
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3622
Practice Address - Country:US
Practice Address - Phone:615-829-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA405805225C00000X
101YM0800X
LA09750225A00000X
TN5001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional