Provider Demographics
NPI:1407457716
Name:FORD, AMANDA B
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 CRYSTAL RANCH RD
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2916
Mailing Address - Country:US
Mailing Address - Phone:805-603-9601
Mailing Address - Fax:
Practice Address - Street 1:12412 CRYSTAL RANCH RD
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2916
Practice Address - Country:US
Practice Address - Phone:805-603-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst