=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487192928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORWARD COUNSELING AND CONSULTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2017
-----------------------------------------------------
Last Update Date | 08/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 ENGEL ST STE 201
-----------------------------------------------------
City | MONONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53713-4822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-455-6070
-----------------------------------------------------
Fax | 608-455-0883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 ENGEL ST STE 201
-----------------------------------------------------
City | MONONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53713-4822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-455-6070
-----------------------------------------------------
Fax | 608-455-6070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST/COFOUNDER
-----------------------------------------------------
Name | MICHELLE MURRAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-455-6070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------