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NPI Profile for THEODORE J WIARD in TAOS, NM.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Mental Health |
101YM0800X | |||
Pastoral |
101YP1600X |
| NPI # | 1790894053 |
|
| Status | Active | |
| Credentials | LPCC | |
| Entity | Individual | |
| Enumeration date | 08/30/2006 | |
| Last updated | 05/21/2024 - About 2 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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THEODORE J WIARD
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THEODORE J WIARD, LPCC