MEDICARE: LAURA MARIE FORD LPCC

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	101YP2500X	Professional Counselor	1805	MN

General Provider Information

NPI Number	:	1518479138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIE FORD LPCC

Provider Business Mailing Address
First Line	:	4749 CHICAGO AVE STE 2B
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-4181
Country	:	US
Telephone Number	:	612-404-0211
Fax Number	:

Provider Business Practice Location Address
First Line	:	4749 CHICAGO AVE STE 2B
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-4181
Country	:	US
Telephone Number	:	612-404-0211
Fax Number	:

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

Provider Enumeration Date	:	11/05/2017
Last Update Date	:	02/29/2024

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