Provider Demographics
NPI:1457595183
Name:WARD, RUPA T (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:RUPA
Middle Name:T
Last Name:WARD
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 MESA VERDE DR E STE 8
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4858
Mailing Address - Country:US
Mailing Address - Phone:714-432-9856
Mailing Address - Fax:714-432-7075
Practice Address - Street 1:2845 MESA VERDE DR E STE 8
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4858
Practice Address - Country:US
Practice Address - Phone:714-432-9856
Practice Address - Fax:714-432-7075
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 59633106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist