Healthcare Provider Details

I. General information

NPI: 1992180954
Provider Name (Legal Business Name): FORWARD PERSPECTIVE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19639 W 12 MILE RD
SOUTHFIELD MI
48076-2550
US

IV. Provider business mailing address

19639 W 12 MILE RD
SOUTHFIELD MI
48076-2550
US

V. Phone/Fax

Practice location:
  • Phone: 313-995-8614
  • Fax:
Mailing address:
  • Phone: 313-995-8614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. HELEMA BALLARD
Title or Position: FOUNDER/COUNSELING
Credential: M.A,, LLPC
Phone: 313-995-8614