Provider Demographics
NPI:1336634856
Name:FORWARD EMOTION, LLC
Entity Type:Organization
Organization Name:FORWARD EMOTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST AND MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, ATR
Authorized Official - Phone:630-999-8236
Mailing Address - Street 1:1440 MAPLE AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-4136
Mailing Address - Country:US
Mailing Address - Phone:630-999-8236
Mailing Address - Fax:
Practice Address - Street 1:1440 MAPLE AVE STE 2B
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-4136
Practice Address - Country:US
Practice Address - Phone:630-999-8236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008646101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12707302OtherCAQH