Provider Demographics
NPI:1043419401
Name:FORD, CHRISTOPHER DENNIS (LSCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DENNIS
Last Name:FORD
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 1/2 MASSACHUSETTS ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2345
Mailing Address - Country:US
Mailing Address - Phone:785-423-4322
Mailing Address - Fax:
Practice Address - Street 1:729 1/2 MASSACHUSETTS ST
Practice Address - Street 2:SUITE 209
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2345
Practice Address - Country:US
Practice Address - Phone:785-423-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS43211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical