Provider Demographics
NPI:1013673227
Name:FORD, TANYA RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:RENEE
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 1:313 TEEL RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2444
Mailing Address - Country:US
Mailing Address - Phone:304-640-7676
Mailing Address - Fax:
Practice Address - Street 1:313 TEEL RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2444
Practice Address - Country:US
Practice Address - Phone:304-640-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health