Healthcare Provider Details

I. General information

NPI: 1447901103
Provider Name (Legal Business Name): CASEY R FORD LPA MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 REYNOLDS RD
GLASGOW KY
42141-1177
US

IV. Provider business mailing address

104 REYNOLDS RD
GLASGOW KY
42141-1177
US

V. Phone/Fax

Practice location:
  • Phone: 270-678-4801
  • Fax: 270-904-6570
Mailing address:
  • Phone: 270-678-4801
  • Fax: 270-904-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: