Provider Demographics
NPI:1477096014
Name:DR DON FORD PSYCHOLOGIST PC
Entity Type:Organization
Organization Name:DR DON FORD PSYCHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:562-458-9849
Mailing Address - Street 1:801 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3839
Mailing Address - Country:US
Mailing Address - Phone:562-458-9849
Mailing Address - Fax:562-947-5883
Practice Address - Street 1:801 E CHAPMAN AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3839
Practice Address - Country:US
Practice Address - Phone:562-458-9849
Practice Address - Fax:562-947-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25512305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA041AMedicare PIN