Provider Demographics
NPI:1609497692
Name:WARD, LAURA BETH (LMCH, CAP, EMDR)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:WARD
Suffix:
Gender:F
Credentials:LMCH, CAP, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6504
Mailing Address - Country:US
Mailing Address - Phone:561-596-0894
Mailing Address - Fax:
Practice Address - Street 1:1700 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-6504
Practice Address - Country:US
Practice Address - Phone:561-596-0894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12863101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123098Medicaid