Provider Demographics
NPI:1679685309
Name:FORD, DONALD (MA, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10490 SW EASTRIDGE ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5030
Mailing Address - Country:US
Mailing Address - Phone:503-297-2413
Mailing Address - Fax:
Practice Address - Street 1:10490 SW EASTRIDGE ST
Practice Address - Street 2:SUITE 130
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5030
Practice Address - Country:US
Practice Address - Phone:503-297-2413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR CO402101YM0800X
OROR TO246106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist