=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649588799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIC WARD, LPC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2010
-----------------------------------------------------
Last Update Date | 09/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2523 CLAY MATHIS RD
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75181-1811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-744-5765
-----------------------------------------------------
Fax | 972-222-3288
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2523 CLAY MATHIS RD
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75181-1811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-744-5765
-----------------------------------------------------
Fax | 972-222-3288
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ERIC ALAN WARD
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 469-744-5765
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 62855
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------