Healthcare Provider Details

I. General information

NPI: 1366787780
Provider Name (Legal Business Name): KAMISHA N FORD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4684 ONTARIO MILLS PKWY STE 200
ONTARIO CA
91764-5151
US

IV. Provider business mailing address

4684 ONTARIO MILLS PKWY STE 200
ONTARIO CA
91764-5151
US

V. Phone/Fax

Practice location:
  • Phone: 424-522-8808
  • Fax: 424-544-0013
Mailing address:
  • Phone: 424-522-8808
  • Fax: 424-544-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT97715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: