Healthcare Provider Details

I. General information

NPI: 1164648721
Provider Name (Legal Business Name): MICHAEL KEITH FORD LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 HWY 478
ANTHONY NM
88021
US

IV. Provider business mailing address

P.O. BOX 4430
ANTHONY NM
88021
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-5101
  • Fax: 575-882-2858
Mailing address:
  • Phone: 575-882-5101
  • Fax: 575-882-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-05659
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: