Provider Demographics
NPI:1598248676
Name:FORD, DORIS JEAN
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:JEAN
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 1:4001 N CLASSEN BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2668
Mailing Address - Country:US
Mailing Address - Phone:405-524-2424
Mailing Address - Fax:
Practice Address - Street 1:4001 N CLASSEN BLVD STE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2668
Practice Address - Country:US
Practice Address - Phone:405-524-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst