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General NPI Number Information
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NPI Number | 1912442765
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Entity Type | Organization
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Legal Business Name | FORPSYCH CORPORATION
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 4217 SMITH RD
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City | CINCINNATI
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State | OH
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Zip | 45212-4107
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Country | US
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Telephone | 513-871-7285
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Fax | 513-871-7285
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Provider Business Mailing Address
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Address Line | 4217 SMITH RD
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City | CINCINNATI
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State | OH
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Zip | 45212-4107
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Country | US
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Telephone | 513-871-7285
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Fax | 513-871-7285
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR
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Name | DR. NICOLE LEISGANG
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Credential | PSY.D.
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Telephone | 513-871-7285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20042365A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6165
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License Number State | OH
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