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General NPI Number Information
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NPI Number | 1831873801
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Entity Type | Organization
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Legal Business Name | FOREST ACADEMY
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 8439 STATE ROAD 26 E
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City | LAFAYETTE
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State | IN
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Zip | 47905-9519
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Country | US
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Telephone | 765-414-0125
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Fax |
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Provider Business Mailing Address
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Address Line | 44 JESTER CT
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City | LAFAYETTE
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State | IN
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Zip | 47905-7608
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Country | US
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Telephone | 765-414-0125
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GRETCHEN SHISSLER
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Credential | MOTR/L
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Telephone | 765-414-0125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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