Provider Demographics
NPI:1295965952
Name:FORD, DONALD BRIAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:BRIAN
Last Name:FORD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3839
Mailing Address - Country:US
Mailing Address - Phone:562-458-9849
Mailing Address - Fax:562-947-5883
Practice Address - Street 1:801 E CHAPMAN AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3839
Practice Address - Country:US
Practice Address - Phone:562-458-9849
Practice Address - Fax:562-947-5883
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25512103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA041AMedicare PIN