Healthcare Provider Details

I. General information

NPI: 1275728347
Provider Name (Legal Business Name): ANN FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E WASHINGTON BLVD STE 2302750E
PASADENA CA
91107-1448
US

IV. Provider business mailing address

1763 NAVARRO AVE
PASADENA CA
91103-1545
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax:
Mailing address:
  • Phone: 626-676-8955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT105653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: