Provider Demographics
NPI:1982188504
Name:WARD, TERESA KAREN (MS, PLMHP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:KAREN
Last Name:WARD
Suffix:
Gender:F
Credentials:MS, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WILLOW AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0827
Mailing Address - Country:US
Mailing Address - Phone:402-704-7619
Mailing Address - Fax:712-256-3168
Practice Address - Street 1:1705 MCPHERSON AVE # GL300
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5175
Practice Address - Country:US
Practice Address - Phone:402-704-7619
Practice Address - Fax:712-256-3168
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health