Provider Demographics
NPI:1043713522
Name:FOREST PATH COUNSELING, PLC
Entity Type:Organization
Organization Name:FOREST PATH COUNSELING, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GUERTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-249-3481
Mailing Address - Street 1:100 STATE ST STE 502
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-4800
Mailing Address - Country:US
Mailing Address - Phone:802-249-3481
Mailing Address - Fax:
Practice Address - Street 1:100 STATE ST STE 502
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-4800
Practice Address - Country:US
Practice Address - Phone:802-249-3481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1033249Medicaid