Provider Demographics
NPI:1982354940
Name:AMY FORSBERG, LCPC, LLC
Entity Type:Organization
Organization Name:AMY FORSBERG, LCPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-648-4941
Mailing Address - Street 1:3106 N SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-1339
Mailing Address - Country:US
Mailing Address - Phone:309-648-4941
Mailing Address - Fax:
Practice Address - Street 1:3106 N SHERWOOD AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-1339
Practice Address - Country:US
Practice Address - Phone:309-648-4941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health