Healthcare Provider Details

I. General information

NPI: 1962230979
Provider Name (Legal Business Name): SAMANTHA FORD PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 6TH ST
PARKVILLE MO
64152-3703
US

IV. Provider business mailing address

400 E 6TH ST
PARKVILLE MO
64152-3703
US

V. Phone/Fax

Practice location:
  • Phone: 816-505-4787
  • Fax: 816-441-3720
Mailing address:
  • Phone: 816-505-4787
  • Fax: 816-441-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2024014807
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: