Provider Demographics
NPI:1609602077
Name:WOOD, EARL (LAPC)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 34TH AVE S APT 1243
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5185
Mailing Address - Country:US
Mailing Address - Phone:573-513-7445
Mailing Address - Fax:
Practice Address - Street 1:2900 34TH AVE S APT 1243
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5185
Practice Address - Country:US
Practice Address - Phone:573-513-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1362-6-1-24A101YP2500X
ND13626124A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional