Provider Demographics
NPI:1083870794
Name:FORD, GLORIA JEAN (MASTERS)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEAN
Last Name:FORD
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:JEAN
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASTERS
Mailing Address - Street 1:5005 S BUTTS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-9331
Mailing Address - Country:US
Mailing Address - Phone:520-908-4600
Mailing Address - Fax:520-908-4601
Practice Address - Street 1:5005 S BUTTS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85757-9331
Practice Address - Country:US
Practice Address - Phone:520-908-4600
Practice Address - Fax:520-908-4601
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool