Doctor Name: | MEGAN ROSHAWN FORD |
NPI Number: | 1003110248 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 110 Skyline Dr Russellville, AR - 728013362 |
Business Phone Number: | 4799675570 |
Business Fax Number: | 4798905364 |
Mailing Address: | 350 Salem Rd, Suite 1 CONWAY |
State: | AR |
Postal Code: | 720347525 |
Phone Number: | 5013368300 |
Fax Number: | 5013295508 |
NPI Enumeration Date: | 01/03/2011 |
NPI Last Update Date: | 01/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |