Healthcare Provider Details

I. General information

NPI: 1881017895
Provider Name (Legal Business Name): KATIE FORSYTHE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 GRAND CANYON PKWY STE 420
HOFFMAN ESTATES IL
60169
US

IV. Provider business mailing address

1401 MAYFIELD LN
HOFFMAN ESTATES IL
60169-2634
US

V. Phone/Fax

Practice location:
  • Phone: 630-254-8304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180008504
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180008504
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: