Provider Demographics
NPI:1073091377
Name:FORD, ANDREA L (LMHC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:FORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 CROSSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-8819
Mailing Address - Country:US
Mailing Address - Phone:317-985-6641
Mailing Address - Fax:
Practice Address - Street 1:429 E VERMONT ST STE 208
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3698
Practice Address - Country:US
Practice Address - Phone:317-528-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003318A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health