=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164890802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORWARD THINKING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2015
-----------------------------------------------------
Last Update Date | 09/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4314 YOAKUM BLVD FL 2
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77006-5865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-468-4254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5340 WESLAYAN ST UNIT 271914
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77277-4091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-468-4254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST/OWNER
-----------------------------------------------------
Name | WENDY EVANS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 281-468-4254
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 25463
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------