Healthcare Provider Details

I. General information

NPI: 1659891653
Provider Name (Legal Business Name): TRICIA MICHELLE FORGASH CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 DORCHESTER DR. N 106
TROY MI
48084
US

IV. Provider business mailing address

1998 DORCHESTER DR N APT 106
TROY MI
48084-8321
US

V. Phone/Fax

Practice location:
  • Phone: 248-361-0716
  • Fax:
Mailing address:
  • Phone: 248-361-0716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number52240
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: