Provider Demographics
NPI:1376908772
Name:WARD, THAD (LCDC)
Entity Type:Individual
Prefix:MR
First Name:THAD
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 EARL GARRETT ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4572
Mailing Address - Country:US
Mailing Address - Phone:830-353-7868
Mailing Address - Fax:
Practice Address - Street 1:550 EARL GARRETT ST
Practice Address - Street 2:SUITE 203
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4572
Practice Address - Country:US
Practice Address - Phone:830-353-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12955101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13675634OtherCAQH