Individual
MRS. AMY D. FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
1601 W 4TH ST, COFFEYVILLE, KS 67337-3333
(620) 252-8180
(620) 332-1940
Mailing address
PO BOX 688, INDEPENDENCE, KS 67301-0688
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
348
KS
1041C0700X
Clinical Social Worker
Primary
LSCSW 3833
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200435870A
—
KS
01
—
6919003
MEDICARE PTAN
KS
Enumeration date
06/19/2006
Last updated
03/27/2014
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