Basic Information
Provider Information
NPI: 1689798498
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WARD
FirstName: CHERYL
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MA, PCCS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P.O. BOX 715194
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432715194
CountryCode: US
TelephoneNumber: 6143558004
FaxNumber: 6143550509
Practice Location
Address1: 399 E MAIN ST
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432155384
CountryCode: US
TelephoneNumber: 6143558550
FaxNumber: 6143558593
Other Information
ProviderEnumerationDate: 03/19/2007
LastUpdateDate: 12/30/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XE0003102OHY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home