Provider Demographics
NPI:1255757845
Name:FORD, ARIEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 SAGEWOOD DR
Mailing Address - Street 2:#434
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-7502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6300 SAGEWOOD DR
Practice Address - Street 2:#434
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7502
Practice Address - Country:US
Practice Address - Phone:435-640-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT79337592501103T00000X
CA19114103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist