Provider Demographics
NPI:1093398059
Name:FORWARD WELLNESS FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:FORWARD WELLNESS FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WISMER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:800-701-0937
Mailing Address - Street 1:1041 E YORBA LINDA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3760
Mailing Address - Country:US
Mailing Address - Phone:800-701-0937
Mailing Address - Fax:
Practice Address - Street 1:1041 E YORBA LINDA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3760
Practice Address - Country:US
Practice Address - Phone:800-701-0937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health