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General NPI Number Information
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NPI Number | 1598144685
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Entity Type | Individual
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Provider Name | TENISHA DIANNE FORD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 14605 GRAHAM AVE
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City | VICTORVILLE
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State | CA
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Zip | 92394-7004
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Country | US
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Telephone | 760-985-4308
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Fax |
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Provider Business Mailing Address
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Address Line | 14605 GRAHAM AVE
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City | VICTORVILLE
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State | CA
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Zip | 92394-7004
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Country | US
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Telephone | 760-514-2889
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Fax | 760-243-9559
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 754506
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 145506
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License Number State | CA
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