Healthcare Provider Details

I. General information

NPI: 1578349437
Provider Name (Legal Business Name): RENEASHA T FORD MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 BERRYWOOD DR
COLUMBIA MO
65201-8372
US

IV. Provider business mailing address

2081 COLLIER CORPORATE PKWY
SAINT CHARLES MO
63303-6701
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-8330
  • Fax:
Mailing address:
  • Phone: 636-255-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2023035768
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: