Provider Demographics
NPI:1093214348
Name:WARD, JIMMY (MS, MDIV)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:MS, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1185
Mailing Address - Street 2:
Mailing Address - City:KASILOF
Mailing Address - State:AK
Mailing Address - Zip Code:99610-1185
Mailing Address - Country:US
Mailing Address - Phone:907-741-2725
Mailing Address - Fax:
Practice Address - Street 1:35109 ROYAL PL
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-9755
Practice Address - Country:US
Practice Address - Phone:907-741-2725
Practice Address - Fax:907-260-7427
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral