Healthcare Provider Details

I. General information

NPI: 1255435723
Provider Name (Legal Business Name): MRS. DEBRA ANN WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 S EASON BLVD
TUPELO MS
38804-6942
US

IV. Provider business mailing address

110 E LEE ST
BALDWYN MS
38824-2207
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-1717
  • Fax: 662-680-6416
Mailing address:
  • Phone: 662-365-9608
  • 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: