Provider Demographics
NPI:1104163708
Name:FORD, JASON DONALD (MFT TRAINEE)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DONALD
Last Name:FORD
Suffix:
Gender:M
Credentials:MFT TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N KAWEAH AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1200
Mailing Address - Country:US
Mailing Address - Phone:559-594-4969
Mailing Address - Fax:559-592-9250
Practice Address - Street 1:516 N KAWEAH AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1200
Practice Address - Country:US
Practice Address - Phone:559-594-4969
Practice Address - Fax:559-592-9250
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health