Provider Demographics
NPI:1164075990
Name:FOREST CITY COUNSELING, LLC
Entity Type:Organization
Organization Name:FOREST CITY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SELANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-520-6972
Mailing Address - Street 1:6735 VISTAGREEN WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5654
Mailing Address - Country:US
Mailing Address - Phone:815-391-3055
Mailing Address - Fax:815-904-6419
Practice Address - Street 1:6735 VISTAGREEN WAY STE 210
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5654
Practice Address - Country:US
Practice Address - Phone:815-391-3055
Practice Address - Fax:815-904-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-21
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty