=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417676131
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORWARD OUTLOOK COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2022
-----------------------------------------------------
Last Update Date | 08/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8009 BRAMBLEWOOD DR APT 2A
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48917-8778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-522-2204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5859 W SAGINAW HWY # 303
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48917-2460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-522-2204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | SARAH CASSANDRA SMITHERS
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 616-522-2204
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------