Provider Demographics
NPI:1962273789
Name:WARD, JACQUELINE (LMSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12517 S HILLCREEK RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-5328
Mailing Address - Country:US
Mailing Address - Phone:830-446-0605
Mailing Address - Fax:
Practice Address - Street 1:3800 PALUXY DR STE 425
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1653
Practice Address - Country:US
Practice Address - Phone:903-714-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110588104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker