=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891246054
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAIL MARIE WARD LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2016
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | INSIGHT COUNSELING AND THERAPY 250 S MAIN ST
-----------------------------------------------------
City | PAYETTE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-405-0020
-----------------------------------------------------
Fax | 208-466-5058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1273 SPRING CREEK LANE UNIT 210
-----------------------------------------------------
City | FRUITLAND
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-556-8848
-----------------------------------------------------
Fax | 208-466-5058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 509591
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | MAC
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6349
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------