MEDICARE: DONALD ALAN FORD LMHC

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	MH12129	FL

General Provider Information

NPI Number	:	1477818953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD ALAN FORD LMHC

Provider Business Mailing Address
First Line	:	3154 RAWCLIFFE RD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34714-6169
Country	:	US
Telephone Number	:	941-677-8350
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 S DE SOTO AVE STE 306
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-7105
Country	:	US
Telephone Number	:	941-677-8350
Fax Number	:

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

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	11/22/2021

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