1316002561 NPI number — BARBARA L FORGUE MA, LPC

Table of content: BARBARA L FORGUE MA, LPC (NPI 1316002561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316002561 NPI number — BARBARA L FORGUE MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORGUE
Provider First Name:
BARBARA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316002561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5344 N BEAUNE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUDINGTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49431-8624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-233-1655
Provider Business Mailing Address Fax Number:
231-853-6250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
337 N JEBAVY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUDINGTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49431-2951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-233-1655
Provider Business Practice Location Address Fax Number:
231-853-6250
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  6401008701 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 6401008701 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1712452 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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