Provider Demographics
NPI:1457539173
Name:FORD, KASEY R
Entity Type:Individual
Prefix:MS
First Name:KASEY
Middle Name:R
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-1439
Mailing Address - Country:US
Mailing Address - Phone:618-263-3873
Mailing Address - Fax:618-263-3893
Practice Address - Street 1:130 W 7TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-1439
Practice Address - Country:US
Practice Address - Phone:618-263-3873
Practice Address - Fax:618-263-3893
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health