Provider Demographics
NPI:1982846549
Name:FORD, AMY (MA LMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29034 216TH AVE SE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-1297
Mailing Address - Country:US
Mailing Address - Phone:425-306-7632
Mailing Address - Fax:425-584-7122
Practice Address - Street 1:27752 254TH WAY SE
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-2035
Practice Address - Country:US
Practice Address - Phone:425-306-7632
Practice Address - Fax:425-584-7122
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-28
Last Update Date:2009-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60031142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health