Provider Demographics
NPI:1720736457
Name:FORD, CALEB ANDREW (PLPC)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:ANDREW
Last Name:FORD
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12801 FLUSHING MEADOWS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1829
Mailing Address - Country:US
Mailing Address - Phone:314-994-9344
Mailing Address - Fax:314-462-9296
Practice Address - Street 1:12801 FLUSHING MEADOWS DR STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1829
Practice Address - Country:US
Practice Address - Phone:314-994-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional