Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003110248 |
---|---|
Provider Name | Megan Roshawn Ford |
First Address | Conway, AR 72034-7525 |
Second Address | Russellville, AR 72801-3362 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2011 |
Last Update Date | 28/01/2015 |