Healthcare Provider Details

I. General information

NPI: 1699694059
Provider Name (Legal Business Name): FORGE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 N BROADWAY ST
GEORGETOWN KY
40324-1302
US

IV. Provider business mailing address

2773 KEARNEY CREEK LN
LEXINGTON KY
40511-8685
US

V. Phone/Fax

Practice location:
  • Phone: 859-433-1913
  • Fax:
Mailing address:
  • Phone: 859-433-1913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ACKER
Title or Position: OWNER
Credential:
Phone: 859-433-1913