Provider Demographics
NPI:1720582844
Name:FORD, ARIEL M (BS, QMHA)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
Credentials:BS, QMHA
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:M
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, QMHA
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:MARYLHURST
Mailing Address - State:OR
Mailing Address - Zip Code:97036-0368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15544 S CLACKAMAS RIVER RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9490
Practice Address - Country:US
Practice Address - Phone:503-635-3416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health