Provider Demographics
NPI:1013495571
Name:FORD, ALYSSA CRYSTAL (MSW,LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:CRYSTAL
Last Name:FORD
Suffix:
Gender:F
Credentials:MSW,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1836
Mailing Address - Country:US
Mailing Address - Phone:733-330-8810
Mailing Address - Fax:
Practice Address - Street 1:203 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1836
Practice Address - Country:US
Practice Address - Phone:573-330-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker