Provider Demographics
NPI:1740219153
Name:FORD, GREG ROSS (PHD)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:ROSS
Last Name:FORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SAMISH WAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2901
Mailing Address - Country:US
Mailing Address - Phone:360-255-2505
Mailing Address - Fax:360-255-2504
Practice Address - Street 1:801 SAMISH WAY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-2901
Practice Address - Country:US
Practice Address - Phone:360-255-2505
Practice Address - Fax:360-255-2504
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002303103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS74732Medicare UPIN
WAG8875678Medicare PIN
WAS74732Medicare UPIN