Healthcare Provider Details

I. General information

NPI: 1154413417
Provider Name (Legal Business Name): NIKKI WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 W ORANGEWOOD AVE SUITE #103
ORANGE CA
92868-2004
US

IV. Provider business mailing address

28610 BRUSH CANYON DR
YORBA LINDA CA
92887-6404
US

V. Phone/Fax

Practice location:
  • Phone: 714-221-6400
  • Fax: 714-221-6401
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: