Provider Demographics
NPI:1508937319
Name:FORD, QUENSHELL L
Entity Type:Individual
Prefix:MS
First Name:QUENSHELL
Middle Name:L
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 1:2125 N VENTURA RD APT B
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2257
Mailing Address - Country:US
Mailing Address - Phone:805-569-1607
Mailing Address - Fax:
Practice Address - Street 1:2125 N VENTURA RD APT B
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2257
Practice Address - Country:US
Practice Address - Phone:805-569-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health