Provider Demographics
NPI:1134454671
Name:FORD, STEPHEN WESLEY (MA PCC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WESLEY
Last Name:FORD
Suffix:
Gender:M
Credentials:MA PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8167
Mailing Address - Country:US
Mailing Address - Phone:740-701-6798
Mailing Address - Fax:
Practice Address - Street 1:7602 SLATE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8157
Practice Address - Country:US
Practice Address - Phone:614-626-2696
Practice Address - Fax:866-820-4098
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0003798101Y00000X
OHE0003798101YA0400X, 101YP1600X
OHEOOO3798101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral