Individual
MADELINE FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5826 AMBROSE CIR, TEMPLE, TX 76502-4404
(214) 433-2700
Mailing address
5826 AMBROSE CIR, TEMPLE, TX 76502-4404
(770) 733-5833
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32078778894
—
TX
Enumeration date
09/21/2021
Last updated
04/06/2023
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