MEDICARE: DESTINY WARD MFT-I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MI4369	NV

General Provider Information

NPI Number	:	1063252435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY WARD MFT-I

Provider Business Mailing Address
First Line	:	10409 PACIFIC PALISADES AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-1221
Country	:	US
Telephone Number	:	702-472-8096
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 N TENAYA WAY STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0480
Country	:	US
Telephone Number	:	702-757-8720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	05/31/2024

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Directions to “ DESTINY WARD MFT-I” Practice Location

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