Provider Demographics
NPI:1588434930
Name:WOODS, CLARETTA DORIS
Entity type:Individual
Prefix:MRS
First Name:CLARETTA
Middle Name:DORIS
Last Name:WOODS
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 1:1009 MEADOWVALE DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7032
Mailing Address - Country:US
Mailing Address - Phone:405-414-9396
Mailing Address - Fax:
Practice Address - Street 1:1009 MEADOWVALE DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7032
Practice Address - Country:US
Practice Address - Phone:405-414-9396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKMC-2016-142101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral