Provider Demographics
NPI:1811382914
Name:JENNA FORAKER,LPC, LLC
Entity Type:Organization
Organization Name:JENNA FORAKER,LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-682-3444
Mailing Address - Street 1:202 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2750
Mailing Address - Country:US
Mailing Address - Phone:816-682-3444
Mailing Address - Fax:
Practice Address - Street 1:202 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2750
Practice Address - Country:US
Practice Address - Phone:816-682-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008030793101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty