=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316002561
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA L FORGUE MA, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2006
-----------------------------------------------------
Last Update Date | 01/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 337 N JEBAVY DR
-----------------------------------------------------
City | LUDINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49431-2951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-233-1655
-----------------------------------------------------
Fax | 231-853-6250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5344 N BEAUNE RD
-----------------------------------------------------
City | LUDINGTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49431-8624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-233-1655
-----------------------------------------------------
Fax | 231-853-6250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 6401008701
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6401008701
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------