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: | 2025-09-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 9630 | 101YP2500X |
TX | 890 | 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 1981LC | Other | LICENSED PROFESSIONAL COU |
TX | 10012781 | Medicaid |