Provider Demographics
NPI:1205035235
Name:FORD, KATIE (MFT,LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:MFT,LPC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:73 SW TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1286
Mailing Address - Country:US
Mailing Address - Phone:661-426-4213
Mailing Address - Fax:
Practice Address - Street 1:143 SW SHEVLIN HIXON DRIVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:661-426-4213
Practice Address - Fax:661-852-2777
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2149101YP2500X
CAMFC35625106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500737088Medicaid