MEDICARE: JEFF WARD & ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1073143657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFF WARD & ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	12805 REVERE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-2959
Country	:	US
Telephone Number	:	216-798-7177
Fax Number	:

Provider Business Practice Location Address
First Line	:	12805 REVERE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-2959
Country	:	US
Telephone Number	:	216-798-7177
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JEFFREY WARD
Credential	:	MSW, LSW, LICDC-CS
Telephone Number	:	216-798-7177

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	01/22/2020

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