| Doctor Name: | KEITH HARRISON FORD |
| NPI Number: | 1245691070 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | CP60026494 |
| Business Practice Address: | 17337 Reservation Rd La Conner, WA - 982578802 |
| Business Phone Number: | 3604661024 |
| Business Fax Number: | 3604667364 |
| Mailing Address: | 17337 Reservation Rd, LA CONNER |
| State: | WA |
| Postal Code: | 982578802 |
| Phone Number: | 3604661024 |
| Fax Number: | 3604667364 |
| NPI Enumeration Date: | 03/07/2016 |
| NPI Last Update Date: | 03/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CP60026494 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |