Provider Demographics
NPI:1568503340
Name:WARD, VANESSA SHARP (MS, LPC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:SHARP
Last Name:WARD
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-0369
Mailing Address - Country:US
Mailing Address - Phone:210-659-1901
Mailing Address - Fax:210-659-4574
Practice Address - Street 1:8555 E LOOP 1604 N
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2915
Practice Address - Country:US
Practice Address - Phone:210-659-1901
Practice Address - Fax:210-659-4574
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16586101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0290942-02Medicaid