Provider Demographics
NPI:1619278462
Name:FORD, ARLA M (QMHP)
Entity Type:Individual
Prefix:
First Name:ARLA
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 VISTA CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2465
Mailing Address - Country:US
Mailing Address - Phone:541-756-7453
Mailing Address - Fax:541-808-0395
Practice Address - Street 1:3803 VISTA CT
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2465
Practice Address - Country:US
Practice Address - Phone:541-756-7453
Practice Address - Fax:541-808-0395
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health