Provider Demographics
NPI:1275201022
Name:WARD, SCOTT (CADC CAS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:CADC CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 E GEM CIR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-2354
Mailing Address - Country:US
Mailing Address - Phone:760-464-2611
Mailing Address - Fax:
Practice Address - Street 1:1473 E GEM CIR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-2354
Practice Address - Country:US
Practice Address - Phone:760-464-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATBD2084P0802X, 320800000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness