Provider Demographics
NPI:1326241274
Name:FORD, NANCY JUNE (MED, LPC, LLD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JUNE
Last Name:FORD
Suffix:
Gender:F
Credentials:MED, LPC, LLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W 8TH AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-2399
Mailing Address - Country:US
Mailing Address - Phone:806-353-1668
Mailing Address - Fax:
Practice Address - Street 1:112 W 8TH AVE STE 800
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-2399
Practice Address - Country:US
Practice Address - Phone:806-353-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12516101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor