Provider Demographics
NPI:1134309743
Name:FORD, CORI RACHELLE I (LMFT)
Entity type:Individual
Prefix:MS
First Name:CORI
Middle Name:RACHELLE
Last Name:FORD
Suffix:I
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MIRAMONTES ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1942
Mailing Address - Country:US
Mailing Address - Phone:510-333-6675
Mailing Address - Fax:
Practice Address - Street 1:625 MIRAMONTES ST STE 201
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1942
Practice Address - Country:US
Practice Address - Phone:510-333-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77801106H00000X
CA133855106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAICAN880OtherL.A. COUNTY DEPARTMENT OF MENTAL HEALTH