1790791408 NPI number — MRS. BRENDA FOWLER FORD LCSW

Table of content: MRS. BRENDA FOWLER FORD LCSW (NPI 1790791408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790791408 NPI number — MRS. BRENDA FOWLER FORD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORD
Provider First Name:
BRENDA
Provider Middle Name:
FOWLER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790791408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36000 DARNALL LOOP
Provider Second Line Business Mailing Address:
CARL R. DARNALL ARMY MEDICAL CENTER
Provider Business Mailing Address City Name:
FORT HOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLDG 2255
Provider Second Line Business Practice Location Address:
DEPARTMENT OF SOCIAL WORK
Provider Business Practice Location Address City Name:
FORT HOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-288-6474
Provider Business Practice Location Address Fax Number:
254-288-8358
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  21896 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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