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General NPI Number Information
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NPI Number | 1962436832
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Entity Type | Individual
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Provider Name | JERRY TODD WARD LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 185 TREUHAFT BLVD
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City | BARBOURVILLE
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State | KY
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Zip | 40906-8303
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Country | US
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Telephone | 606-546-2757
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Fax |
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Provider Business Mailing Address
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Address Line | 106 BELINDA BLVD SUITE 100
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City | DANVILLE
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State | KY
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Zip | 40422-3217
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Country | US
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Telephone | 859-209-4286
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Fax | 859-209-4278
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1574
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License Number State | KY
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