Provider Demographics
NPI:1912193038
Name:FORD, LORA R (PSYD PLLC)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:R
Last Name:FORD
Suffix:
Gender:F
Credentials:PSYD PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 W MERCER WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2540
Mailing Address - Country:US
Mailing Address - Phone:206-632-6000
Mailing Address - Fax:
Practice Address - Street 1:3035 ISLAND CREST WAY
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2919
Practice Address - Country:US
Practice Address - Phone:206-632-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60004824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical