Provider Demographics
NPI:1376007963
Name:WARD, WESTON BRENT (LPC)
Entity Type:Individual
Prefix:
First Name:WESTON
Middle Name:BRENT
Last Name:WARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 HALLVALE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-1427
Mailing Address - Country:US
Mailing Address - Phone:214-437-6334
Mailing Address - Fax:
Practice Address - Street 1:108 S BRAZOS ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4212
Practice Address - Country:US
Practice Address - Phone:682-514-9225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76047101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty