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General NPI Number Information
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NPI Number | 1336621291
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Entity Type | Organization
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Legal Business Name | WESLEY WARD PH.D LLC
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 100 SAW MILL RD STE 3104
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City | LAFAYETTE
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State | IN
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Zip | 47905-5598
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Country | US
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Telephone | 765-409-9136
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Fax |
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Provider Business Mailing Address
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Address Line | 1028 KILLIAN DR
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City | MOORESVILLE
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State | IN
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Zip | 46158-7995
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. WESLEY WARD
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Credential | PH.D
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Telephone | 765-409-9136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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