MEDICARE: TINA WARD

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	101YM0800X	Mental Health Counselor	90663	TX

General Provider Information

NPI Number	:	1770281131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA WARD

Provider Business Mailing Address
First Line	:	5225 LAS COLINAS BLVD APT 2052
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-4559
Country	:	US
Telephone Number	:	940-227-5859
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 LAS COLINAS BLVD APT 2052
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-4559
Country	:	US
Telephone Number	:	940-227-5859
Fax Number	:

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

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	02/15/2023

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