Basic Information
| Provider Information | |||||||||
| NPI: | 1255645495 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORD | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DBH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1016 SW 44TH ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056054249 | ||||||||
| FaxNumber: | 4056050255 | ||||||||
| Practice Location | |||||||||
| Address1: | 1016 SW 44TH ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056054249 | ||||||||
| FaxNumber: | 4056050255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2010 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2279C0205X | 1836 | OK | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Critical Care | 101YM0800X | OK | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.