1962436832 NPI number — JERRY TODD WARD LCSW

Table of content: JERRY TODD WARD LCSW (NPI 1962436832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962436832 NPI number — JERRY TODD WARD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
JERRY
Provider Middle Name:
TODD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

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:
1962436832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 BELINDA BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40422-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-209-4286
Provider Business Mailing Address Fax Number:
859-209-4278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 TREUHAFT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARBOURVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40906-8303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-546-2757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2006

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: 1041C0700X , with the licence number:  1574 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1197004 . This is a "CHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541568 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30610026 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 800013193 . This is a "PALMETTO - RR MCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000227561 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 279367 . This is a "MANAGED HEALTH" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com