Provider Demographics
NPI:1912594128
Name:FORD, ELIZABETH CHRISTINA (LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHRISTINA
Last Name:FORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 MOORE BUILDING
Mailing Address - Street 2:PENN STATE UNIVERSITY
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16801-3231
Mailing Address - Country:US
Mailing Address - Phone:814-865-2191
Mailing Address - Fax:
Practice Address - Street 1:337 MOORE BUILDING
Practice Address - Street 2:PENN STATE UNIVERSITY
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16801-3231
Practice Address - Country:US
Practice Address - Phone:814-865-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional