Provider Demographics
NPI:1730241175
Name:WOOD, GREGORY THOMAS (MFT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:THOMAS
Last Name:WOOD
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 MARICOPA HWY
Mailing Address - Street 2:SUITE 222
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3162
Mailing Address - Country:US
Mailing Address - Phone:805-662-0023
Mailing Address - Fax:805-640-0776
Practice Address - Street 1:1211 MARICOPA HWY
Practice Address - Street 2:SUITE 222
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3162
Practice Address - Country:US
Practice Address - Phone:805-662-0023
Practice Address - Fax:805-640-0776
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32274106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist