Jack D Woodburn, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401000326 Issued in MI

Practice address

1101 Military St
Port Huron, MI 48060-5418

Phone

(810) 984-5575

Fax

(810) 984-6433

NPI assigned

Jul 2, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Colonial Woods Missionary Church

  • Clinic/Center
  • Port Huron, MI
  • NPI 1033372818
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214956800000",
    "number": "1306009196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MILITARY ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605418",
            "telephone_number": "810-984-5575",
            "fax_number": "810-984-6433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MILITARY ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605418",
            "telephone_number": "810-984-5575",
            "fax_number": "810-984-6433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODBURN",
        "first_name": "JACK",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-02",
        "last_updated": "2008-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401000326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gaye Elizabeth Wolschlager, CCC/SLP
• Todd William Wolschlager, ATC
• Karen Margaret Wood, LLMSW
• Kersten Wood, MSN, FNP-C
• Nathan Maxon Woodard
• Staci Woods, OTR/L
• Woodward Detroit CVS, L.L.C.
• Stephanie N. Worthy
• Wow Therapy
• Beverley Wressell

• Professional Counselor in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.