Provider Demographics
NPI:1508873399
Name:WARD, WALTER JOEL (LPC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JOEL
Last Name:WARD
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 CLIFF MANOR ST
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-3808
Mailing Address - Country:US
Mailing Address - Phone:817-237-0599
Mailing Address - Fax:817-237-1232
Practice Address - Street 1:1550 CLIFF MANOR ST
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3808
Practice Address - Country:US
Practice Address - Phone:817-237-0599
Practice Address - Fax:817-237-1232
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9630101YP2500X
TX890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1981LCOtherLICENSED PROFESSIONAL COU
TX10012781Medicaid