MEDICARE: MR. TERENCE FORD MA

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	106H00000X	Marriage & Family Therapist	49861	CA

General Provider Information

NPI Number	:	1326331935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERENCE FORD MA

Provider Business Mailing Address
First Line	:	660 S FIGUEROA ST
Second Line	:	SUITE 1030
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3442
Country	:	US
Telephone Number	:	213-400-3474
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 S FIGUEROA ST
Second Line	:	SUITE 1030
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3442
Country	:	US
Telephone Number	:	213-400-3474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	09/06/2015

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