Provider Demographics
NPI:1104042407
Name:WARD, SERENA J (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:SERENA
Middle Name:J
Last Name:WARD
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344593 E 990 RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-4231
Mailing Address - Country:US
Mailing Address - Phone:405-596-3833
Mailing Address - Fax:
Practice Address - Street 1:344593 E 990 RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-4231
Practice Address - Country:US
Practice Address - Phone:405-596-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK214365L101YA0400X
OK101YP2500X
OK4722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)