Provider Demographics
NPI:1447901103
Name:FORD, CASEY R (LPA MA)
Entity type:Individual
Prefix:MR
First Name:CASEY
Middle Name:R
Last Name:FORD
Suffix:
Gender:M
Credentials:LPA MA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:104 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1177
Mailing Address - Country:US
Mailing Address - Phone:270-678-4801
Mailing Address - Fax:270-904-6570
Practice Address - Street 1:104 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1177
Practice Address - Country:US
Practice Address - Phone:270-678-4801
Practice Address - Fax:270-904-6570
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling