Provider Demographics
NPI:1235482092
Name:WARD, AUSTIN (MS)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9682
Mailing Address - Country:US
Mailing Address - Phone:615-351-5096
Mailing Address - Fax:
Practice Address - Street 1:60 LYNOAK CV
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2909
Practice Address - Country:US
Practice Address - Phone:731-668-7593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional