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General NPI Number Information
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NPI Number | 1336634856
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Entity Type | Organization
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Legal Business Name | FORWARD EMOTION, LLC
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 1440 MAPLE AVE STE 2B
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City | LISLE
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State | IL
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Zip | 60532-4136
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Country | US
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Telephone | 630-999-8236
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 MAPLE AVE STE 2B
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City | LISLE
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State | IL
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Zip | 60532-4136
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Country | US
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Telephone | 630-999-8236
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Fax |
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Authorized Official
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Title or Position | THERAPIST AND MANAGING MEMBER/OWNER
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Name | LAURA ANN CLAY
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Credential | LCPC, ATR
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Telephone | 630-999-8236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.008646
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.008646
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License Number State | IL
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