1487689725 NPI number — MS. ELIZABETH THERESSE WARD LMFT

Table of content: MS. ELIZABETH THERESSE WARD LMFT (NPI 1487689725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487689725 NPI number — MS. ELIZABETH THERESSE WARD LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
ELIZABETH
Provider Middle Name:
THERESSE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487689725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 BRISTOL ST N
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92660-2911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-697-9334
Provider Business Mailing Address Fax Number:
949-589-5767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 BRISTOL ST N
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660-2911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-697-9334
Provider Business Practice Location Address Fax Number:
949-589-5767
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC29328 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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