Organization Name: | T.WIARD, LLC |
NPI Number: | 1942637517 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | THEODORE JOHN WIARD (CHIEF EXECUTIVE OFFICER) |
Mailing Address: | 07 Callecita Arroyo Hondo |
State: | NM US |
Postal Code: | 87513 |
Phone Number: | 5056900126 |
Fax Number: | |
NPI Enumeration Date: | 09/27/2013 |
NPI Last Update Date: | 09/27/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 0109811 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |