Individual
RENNA LYNN FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDC
Contact information
Practice address
445 S CENTER ST, ELSINORE, UT 84724-7701
(435) 979-6645
Mailing address
PO BOX 212, ELSINORE, UT 84724-0212
(435) 979-6645
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
274670-6005
UT
Other
Enumeration date
08/28/2023
Last updated
08/28/2023
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