Basic Information
| Provider Information | |||||||||
| NPI: | 1598951766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | CLINTON | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2118 CATON WAY S.W. | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609705026 | ||||||||
| FaxNumber: | 3603523289 | ||||||||
| Practice Location | |||||||||
| Address1: | 2118 CATON WAY SW | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985021105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609705026 | ||||||||
| FaxNumber: | 3603523289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 07/28/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH00008619 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.