Healthcare Provider Details

I. General information

NPI: 1568308369
Provider Name (Legal Business Name): FOREGLOW THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 W BUIST AVE
PHOENIX AZ
85041-9003
US

IV. Provider business mailing address

140 W BUIST AVE
PHOENIX AZ
85041-9003
US

V. Phone/Fax

Practice location:
  • Phone: 517-420-7280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE GESELL
Title or Position: OWNER
Credential: LCSW
Phone: 517-420-7280