Provider Demographics
NPI:1063252435
Name:WARD, DESTINY (MFT-I)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 PACIFIC PALISADES AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-1221
Mailing Address - Country:US
Mailing Address - Phone:702-472-8096
Mailing Address - Fax:
Practice Address - Street 1:2701 N TENAYA WAY STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0480
Practice Address - Country:US
Practice Address - Phone:702-757-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4369106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist