Provider Demographics
NPI:1790236909
Name:MELISSA A. FORSCHLER, LMFT, LLC
Entity Type:Organization
Organization Name:MELISSA A. FORSCHLER, LMFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:706-410-8723
Mailing Address - Street 1:1360 CADUCEUS WAY BLDG 400
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7300
Mailing Address - Country:US
Mailing Address - Phone:706-286-8442
Mailing Address - Fax:
Practice Address - Street 1:1360 CADUCEUS WAY BLDG 400
Practice Address - Street 2:SUITE 102
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7300
Practice Address - Country:US
Practice Address - Phone:706-286-8442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-23
Last Update Date:2016-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0001319106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000606328AMedicaid