Provider Demographics
NPI:1073170908
Name:FORGUE, RONALD D (QMHP)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:FORGUE
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 W 100TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1657
Mailing Address - Country:US
Mailing Address - Phone:773-445-4784
Mailing Address - Fax:708-575-2876
Practice Address - Street 1:2608 W 100TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1657
Practice Address - Country:US
Practice Address - Phone:773-445-4784
Practice Address - Fax:708-575-2876
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.018519101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health