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General NPI Number Information
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NPI Number | 1407406721
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Entity Type | Individual
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Provider Name | BRITTANY FORMAN LPC
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Gender | Female
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 117 E 3RD ST REAR
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City | UHRICHSVILLE
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State | OH
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Zip | 44683-1818
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Country | US
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Telephone | 740-922-2144
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 NOBLE DR
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City | WOOSTER
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State | OH
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Zip | 44691-5353
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Country | US
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Telephone | 330-264-3232
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1901911
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License Number State | OH
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