Provider Demographics
NPI:1326331935
Name:FORD, TERENCE (MA)
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S FIGUEROA ST
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3442
Mailing Address - Country:US
Mailing Address - Phone:213-400-3474
Mailing Address - Fax:
Practice Address - Street 1:660 S FIGUEROA ST
Practice Address - Street 2:SUITE 1030
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3442
Practice Address - Country:US
Practice Address - Phone:213-400-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2015-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49861106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist