Provider Demographics
NPI:1003947524
Name:FORD-FERRELL, DONNA JEAN (MA)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JEAN
Last Name:FORD-FERRELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:ALESSANDRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:711 BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2138
Mailing Address - Country:US
Mailing Address - Phone:719-384-5446
Mailing Address - Fax:719-384-5672
Practice Address - Street 1:3500 1ST ST S
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-4327
Practice Address - Country:US
Practice Address - Phone:719-336-7501
Practice Address - Fax:719-336-7453
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1976101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional