Provider Demographics
NPI:1568208080
Name:WOOD, NITA MAE (ACMHC)
Entity type:Individual
Prefix:
First Name:NITA
Middle Name:MAE
Last Name:WOOD
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 N REDWOOD RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-6759
Mailing Address - Country:US
Mailing Address - Phone:385-202-5645
Mailing Address - Fax:
Practice Address - Street 1:2179 N REDWOOD RD UNIT 2
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-6759
Practice Address - Country:US
Practice Address - Phone:385-202-5645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13980237-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty