MEDICARE: ZACHARY MITCHELL WARD LAC

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	101Y00000X	Counselor	A2310014	AR

General Provider Information

NPI Number	:	1154103752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY MITCHELL WARD LAC

Provider Business Mailing Address
First Line	:	620 S 21ST ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-3915
Country	:	US
Telephone Number	:	479-785-4083
Fax Number	:	479-434-6248

Provider Business Practice Location Address
First Line	:	1055 SUNFLOWER DR STE 104
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-3651
Country	:	US
Telephone Number	:	501-697-6631
Fax Number	:	479-434-6248

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

Provider Enumeration Date	:	10/18/2023
Last Update Date	:	10/18/2023

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