Active NPI
Clinton Tyler Wood, LCMHC
- Mental Health Counselor
- Burlington, VT
National Provider Identifier
1760690150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 068-0000137
- Practice address
- 50 Mansfield Avenue
Mater Christi School
Burlington, VT 05401 - Phone
- (802) 658-3992
- NPI assigned
- May 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 068-0000137 | VT | Primary |
Addresses
Primary practice location
50 Mansfield Avenue
Mater Christi School
Burlington, VT 05401
Mailing address
96 Lopes Ave
Burlington, VT 05401-2535
Phone (802) 860-6463
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 068-0000137 | VT | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760690150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "96 LOPES AVE",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054012535",
"telephone_number": "802-860-6463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 MANSFIELD AVENUE",
"address_2": "MATER CHRISTI SCHOOL",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "05401",
"telephone_number": "802-658-3992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOD",
"first_name": "CLINTON",
"middle_name": "TYLER",
"name_prefix": "Mr.",
"credential": "LCMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "VT",
"license": "068-0000137",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.