Provider Demographics
NPI:1427373406
Name:DONALD FORD COUNSELING, LLC
Entity Type:Organization
Organization Name:DONALD FORD COUNSELING, LLC
Other - Org Name:DONALD FORD, MA, LPC, LMFT
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LMFT
Authorized Official - Phone:503-297-2413
Mailing Address - Street 1:10490 S.W. EASTRIDGE ST.,
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225
Mailing Address - Country:US
Mailing Address - Phone:503-297-2413
Mailing Address - Fax:
Practice Address - Street 1:10490 SW EASTRIDGE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5030
Practice Address - Country:US
Practice Address - Phone:503-297-2413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO402101YM0800X
ORTO246106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty