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General NPI Number Information
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NPI Number | 1780328534
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Entity Type | Individual
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Provider Name | CORYANNAH FORD
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Gender | Female
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 21727 IH 10 W STE 108
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City | SAN ANTONIO
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State | TX
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Zip | 78257-2108
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Country | US
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Telephone | 210-445-1091
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Fax |
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Provider Business Mailing Address
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Address Line | 17038 BULVERDE RD APT 1156
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City | SAN ANTONIO
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State | TX
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Zip | 78247-1040
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Country | US
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Telephone | 210-780-9409
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-213300
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License Number State | TX
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