Healthcare Provider Details

I. General information

NPI: 1154678274
Provider Name (Legal Business Name): WHITNEY N FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N 1ST AVE
DURANT OK
74701-3801
US

IV. Provider business mailing address

PO BOX 48
MEAD OK
73449-0048
US

V. Phone/Fax

Practice location:
  • Phone: 580-931-3008
  • Fax: 580-931-8022
Mailing address:
  • Phone: 580-745-9610
  • Fax: 580-745-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: