MEDICARE: AMY FORSBERG, LCPC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1982354940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY FORSBERG, LCPC, LLC

Provider Business Mailing Address
First Line	:	3106 N SHERWOOD AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-1339
Country	:	US
Telephone Number	:	309-648-4941
Fax Number	:

Provider Business Practice Location Address
First Line	:	3106 N SHERWOOD AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-1339
Country	:	US
Telephone Number	:	309-648-4941
Fax Number	:

Authorized Official
Title or Position	:	OWNER/COUNSELOR
Name	:	AMY FORSBERG
Credential	:	LCPC
Telephone Number	:	309-648-4941

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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