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General NPI Number Information
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NPI Number | 1174349054
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Entity Type | Organization
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Legal Business Name | FLUTY AND FORD BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 221 NW 3RD ST APT 3
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City | NEWPORT
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State | OR
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Zip | 97365-3649
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Country | US
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Telephone | 209-298-5277
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Fax |
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Provider Business Mailing Address
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Address Line | 146 SE 1ST ST
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City | NEWPORT
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State | OR
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Zip | 97365-4431
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Country | US
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Telephone | 209-298-5277
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | JOHN BRIAN FORD
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Credential | LMFT
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Telephone | 209-298-5277
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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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