Provider Demographics
NPI:1932348190
Name:FORD, NATHANIEL J (LPCI)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:J
Last Name:FORD
Suffix:
Gender:M
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 N INTERSTATE HIGHWAY 35 E
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5603
Mailing Address - Country:US
Mailing Address - Phone:972-617-6222
Mailing Address - Fax:
Practice Address - Street 1:6350 N INTERSTATE HIGHWAY 35 E
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5603
Practice Address - Country:US
Practice Address - Phone:972-617-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64895101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor