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General NPI Number Information
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NPI Number | 1730791492
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Entity Type | Organization
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Legal Business Name | FORWARD INTENTIONS THERAPY LLC
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Dates
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Enumeration Date | 08/23/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 1309 N ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60622-8744
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Country | US
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Telephone | 847-668-6250
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 N ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60622-8744
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER/THERAPIST
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Name | JILLIAN POTESHMAN
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Credential | LCPC
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Telephone | 312-945-8798
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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 |
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License Number State |
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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 |
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License Number State |
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