Provider Demographics
NPI:1467997361
Name:FORWARD FOCUS PSYCHOLOGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:FORWARD FOCUS PSYCHOLOGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST - DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:GARERA
Authorized Official - Last Name:IZQUIERDO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:859-869-4463
Mailing Address - Street 1:7413 US HIGHWAY 42 STE 3
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1999
Mailing Address - Country:US
Mailing Address - Phone:859-869-4463
Mailing Address - Fax:859-869-4476
Practice Address - Street 1:7413 US HIGHWAY 42 STE 3
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1999
Practice Address - Country:US
Practice Address - Phone:859-869-4463
Practice Address - Fax:859-869-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
KY130270103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty