Provider Demographics
NPI:1295877298
Name:FORD, MICHELE PATTERSON (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:PATTERSON
Last Name:FORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:MARIA
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:884 LAUREL HILL CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-5901
Mailing Address - Country:US
Mailing Address - Phone:512-484-1016
Mailing Address - Fax:512-346-8509
Practice Address - Street 1:4810B SPICEWOOD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-484-1016
Practice Address - Fax:512-346-8509
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32420103TC1900X
TN2367103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23LJMedicare UPIN