MEDICARE: DR. ARIEL FORD PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	79337592501	UT
2	103T00000X	Psychologist	19114	CA

General Provider Information

NPI Number	:	1255757845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARIEL FORD PSYD

Provider Business Mailing Address
First Line	:	6300 SAGEWOOD DR
Second Line	:	#434
City	:	PARK CITY
State	:	UT
Zip	:	84098-7502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 SAGEWOOD DR
Second Line	:	#434
City	:	PARK CITY
State	:	UT
Zip	:	84098-7502
Country	:	US
Telephone Number	:	435-640-7903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2014
Last Update Date	:	03/06/2014

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Directions to “ DR. ARIEL FORD PSYD” Practice Location

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