Provider Demographics
NPI:1487689725
Name:WARD, ELIZABETH THERESSE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:THERESSE
Last Name:WARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BRISTOL ST N
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2911
Mailing Address - Country:US
Mailing Address - Phone:949-697-9334
Mailing Address - Fax:949-589-5767
Practice Address - Street 1:1400 BRISTOL ST N
Practice Address - Street 2:SUITE 250
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2911
Practice Address - Country:US
Practice Address - Phone:949-697-9334
Practice Address - Fax:949-589-5767
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29328106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist