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General NPI Number Information
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NPI Number | 1144866096
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Entity Type | Organization
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Legal Business Name | KATIE FORD LPC MFT
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 2500 NE TWIN KNOLLS DR STE 260
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City | BEND
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State | OR
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Zip | 97701-4786
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Country | US
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Telephone | 661-426-4213
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Fax |
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Provider Business Mailing Address
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Address Line | 73 SW TAFT AVE
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City | BEND
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State | OR
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Zip | 97702-1286
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Country | US
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Telephone | 661-426-4213
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. KATIE FORD
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Credential | LPC, MFT
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Telephone | 661-426-4213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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