Provider Demographics
NPI:1316002561
Name:FORGUE, BARBARA L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:FORGUE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5344 N BEAUNE RD
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-8624
Mailing Address - Country:US
Mailing Address - Phone:231-233-1655
Mailing Address - Fax:231-853-6250
Practice Address - Street 1:337 N JEBAVY DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2951
Practice Address - Country:US
Practice Address - Phone:231-233-1655
Practice Address - Fax:231-853-6250
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008701101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1712452Medicaid
MI750910910Medicare UPIN
MI750910482Medicare UPIN
MI20378Medicare UPIN
MI750910903Medicare UPIN
MI20366Medicare UPIN
MI750910902Medicare UPIN
MI20386Medicare UPIN
MI750910904Medicare UPIN
MIOP22320Medicare ID - Type Unspecified
MI1712452Medicaid