Healthcare Provider Details

I. General information

NPI: 1598144685
Provider Name (Legal Business Name): TENISHA DIANNE FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17800 US HIGHWAY 18
APPLE VALLEY CA
92307-1221
US

IV. Provider business mailing address

17800 US HIGHWAY 18
APPLE VALLEY CA
92307-1221
US

V. Phone/Fax

Practice location:
  • Phone: 760-552-6700
  • Fax:
Mailing address:
  • Phone: 760-552-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145506
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number754506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: