MEDICARE: DONALD WARD JR.

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	12698	TX

General Provider Information

NPI Number	:	1942683131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD WARD JR.

Provider Business Mailing Address
First Line	:	1259 BARTLETT COVE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77067-3512
Country	:	US
Telephone Number	:	832-352-7892
Fax Number	:

Provider Business Practice Location Address
First Line	:	1259 BARTLETT COVE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77067-3512
Country	:	US
Telephone Number	:	832-352-7892
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	07/07/2015

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Directions to “ DONALD WARD JR. ” Practice Location

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