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General NPI Number Information
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NPI Number | 1447934583
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Entity Type | Individual
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Provider Name | JOHN MARK FORD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 4601 50TH ST STE 200
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City | LUBBOCK
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State | TX
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Zip | 79414-3518
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Country | US
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Telephone | 806-828-0065
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 93242
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City | LUBBOCK
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State | TX
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Zip | 79493-3242
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Country | US
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Telephone | 806-329-8150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 64017
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16666
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 92485
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License Number State | TX
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