Provider Demographics
NPI:1972660512
Name:FORD, CHRISTINA ELAINE (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ELAINE
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 1:5510 PINTO LN
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-5017
Mailing Address - Country:US
Mailing Address - Phone:806-676-3964
Mailing Address - Fax:
Practice Address - Street 1:5510 PINTO LN
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-5017
Practice Address - Country:US
Practice Address - Phone:806-676-3964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60937101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional