Carla Ann Ford, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34005252A Issued in IN

Practice address

1758 W 100S
Jay County Hopsital Behavioral Health
Portland, IN 47371

Phone

(260) 726-1865

Fax

(260) 726-1901

NPI assigned

Mar 23, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Carla Ann Nichols Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455494400000",
    "number": "1922125384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1758 W 100S",
            "address_2": "JAY COUNTY HOPSITAL BEHAVIORAL HEALTH",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "47371",
            "telephone_number": "260-726-1865",
            "fax_number": "260-726-1901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1758 W 100S",
            "address_2": "JAY COUNTY HOPSITAL BEHAVIORAL HEALTH",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "47371",
            "telephone_number": "260-726-1865",
            "fax_number": "260-726-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORD",
        "first_name": "CARLA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2016-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34005252A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLA",
            "last_name": "NICHOLS",
            "middle_name": "ANN",
            "prefix": "MRS.",
            "credential": "L.C.S.W.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Thomas EMS, MD
• Kyle Epler, LPN
• Eye Center Group, LLC
• Family Practice of Jay County
• Rebekah S Ferrell, RN, FNP
• David A Fullenkamp, O.D.
• Ruth A Funk
• Oakland Lawrence Gaerke, D.C.
• Todd Gaerke
• Betsi Gagle

• Clinical Social Worker in Portland, IN
• Providers in Portland, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.