Healthcare Provider Details

I. General information

NPI: 1568649481
Provider Name (Legal Business Name): TAMMY M FORCKE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY PEARSON

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 W COLT SQUARE DR SUITE 4
FAYETTEVILLE AR
72703
US

IV. Provider business mailing address

P.O. BOX 1025
FAYETTEVILLE AR
72702
US

V. Phone/Fax

Practice location:
  • Phone: 479-268-2874
  • Fax: 479-282-2971
Mailing address:
  • Phone: 479-268-2874
  • Fax: 479-282-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1508093
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1508093
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: