Provider Demographics
NPI:1154648731
Name:FORD, CARLETTA (BA IN PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:CARLETTA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:BA IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9613 S ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-5303
Mailing Address - Country:US
Mailing Address - Phone:405-414-3673
Mailing Address - Fax:
Practice Address - Street 1:9613 S ALLEN DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-5303
Practice Address - Country:US
Practice Address - Phone:405-414-3673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor