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General NPI Number Information
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NPI Number | 1962941856
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Entity Type | Organization
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Legal Business Name | FORWARD PATH COUNSELING
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 520 N MAIN ST SUITE 201
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City | CHEBOYGAN
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State | MI
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Zip | 49721-1162
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Country | US
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Telephone | 231-445-1691
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 TROUT CREEK RD
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City | CHEBOYGAN
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State | MI
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Zip | 49721-8597
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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 | OWNER
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Name | LYNETTE DEPETER-SCHULZ
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Credential | M.A., L.M.S.W.
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Telephone | 231-445-1691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801085202
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License Number State | MI
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