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General NPI Number Information
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NPI Number | 1407713563
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Entity Type | Organization
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Legal Business Name | FORWARD PATH MKE
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 2054 S 96TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53227-1425
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Country | US
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Telephone | 262-450-5767
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Fax |
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Provider Business Mailing Address
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Address Line | 2054 S 96TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53227-1425
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Country | US
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Telephone | 262-450-5767
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MR. JUAN CORRAL JR.
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Credential | M.S.,LPC, CSAT
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Telephone | 262-450-5767
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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 |
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License Number State |
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