MEDICARE: BARBARA ALLEN FORD LMFT, CAC II

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	6455	CO
2	101YP2500X	Professional Counselor	4600	CO
3	106H00000X	Marriage & Family Therapist	739	CO

General Provider Information

NPI Number	:	1790980035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA ALLEN FORD LMFT, CAC II

Provider Business Mailing Address
First Line	:	1539 MONROE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1825
Country	:	US
Telephone Number	:	720-468-1463
Fax Number	:	303-322-9699

Provider Business Practice Location Address
First Line	:	1766 HIGH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1309
Country	:	US
Telephone Number	:	720-468-1463
Fax Number	:

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/30/2007

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