Provider Demographics
NPI:1962064642
Name:FORD, CHLOE CELESTE
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:CELESTE
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 DORAL CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5030
Mailing Address - Country:US
Mailing Address - Phone:480-536-0480
Mailing Address - Fax:
Practice Address - Street 1:181 SAND CREEK RD # C-1
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2257
Practice Address - Country:US
Practice Address - Phone:480-536-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician