Healthcare Provider Details

I. General information

NPI: 1316675747
Provider Name (Legal Business Name): AIMEE FORD AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 S MARENGO AVE
PASADENA CA
91101-3128
US

IV. Provider business mailing address

491 S MARENGO AVE
PASADENA CA
91101-3128
US

V. Phone/Fax

Practice location:
  • Phone: 805-299-5068
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: