Provider Demographics
NPI:1609387323
Name:FORD, KAYLIN (LPC)
Entity Type:Individual
Prefix:
First Name:KAYLIN
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3359
Mailing Address - Country:US
Mailing Address - Phone:301-526-6311
Mailing Address - Fax:
Practice Address - Street 1:506 HAWS AVE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-4543
Practice Address - Country:US
Practice Address - Phone:301-526-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8099101YP2500X
PAPC012325101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD383876389Medicaid