Healthcare Provider Details

I. General information

NPI: 1407266323
Provider Name (Legal Business Name): FORWARD COUNSELING, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 COLONIAL RD STE 2
MEMPHIS TN
38117-4019
US

IV. Provider business mailing address

560 COLONIAL RD STE 201
MEMPHIS TN
38117-4097
US

V. Phone/Fax

Practice location:
  • Phone: 901-315-8625
  • Fax: 901-244-6528
Mailing address:
  • Phone: 901-930-7397
  • Fax: 901-244-6548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW0000005676
License Number StateTN

VIII. Authorized Official

Name: JESSICA SHEA
Title or Position: OWNER/MANAGER/THERAPIST
Credential: LCSW
Phone: 901-315-8625