Provider Demographics
NPI:1780702910
Name:WARDFORD, MICHAEL L (LCSW, LMFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:WARDFORD
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11527 TOP WALNUT LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2488
Mailing Address - Country:US
Mailing Address - Phone:502-387-3415
Mailing Address - Fax:
Practice Address - Street 1:332 W BROADWAY STE 902
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-589-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0364106H00000X
KYKY-9941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY82009945Medicaid
KYS527.87Medicare UPIN
KYCSW0202 BRODWAYMedicare ID - Type Unspecified