Provider Demographics
NPI:1083633259
Name:MONELL, FORD T (MFT)
Entity Type:Individual
Prefix:
First Name:FORD
Middle Name:T
Last Name:MONELL
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 LIME AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4640
Mailing Address - Country:US
Mailing Address - Phone:562-307-2743
Mailing Address - Fax:
Practice Address - Street 1:101 S KRAEMER BLVD
Practice Address - Street 2:STE. 110
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6105
Practice Address - Country:US
Practice Address - Phone:562-307-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41277106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist