MEDICARE: KAREN FORD, LICENSED COUNSELOR, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1225607377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN FORD, LICENSED COUNSELOR, LLC

Provider Business Mailing Address
First Line	:	1400 LOWELL RD
Second Line	:
City	:	CONCORD
State	:	MA
Zip	:	01742-5210
Country	:	US
Telephone Number	:	617-610-5046
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 BEDFORD ST STE 1
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4438
Country	:	US
Telephone Number	:	617-610-5046
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	KAREN LANDIS FORD
Credential	:	LMHC
Telephone Number	:	617-610-5046

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	06/23/2021

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