| Forward Family Therapy, Llc | |
|
1035 W Glen Oaks Ln Ste 204 Mequon WI 53092-3395 | |
| (262) 421-5101 | |
| Not Available |
| Full Name | Forward Family Therapy, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1035 W Glen Oaks Ln Ste 204, Mequon, Wisconsin |
| Authorized Official Name and Position | Jennifer Kempfert Kempfert (CO-OWNER) |
| Authorized Official Contact | 2624215101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Forward Family Therapy, Llc 1035 W Glen Oaks Ln Ste 204 Mequon WI 53092-3395 Ph: (262) 421-5101 | Forward Family Therapy, Llc 1035 W Glen Oaks Ln Ste 204 Mequon WI 53092-3395 Ph: (262) 421-5101 |
| NPI Number | 1487293858 |
|---|---|
| Provider Enumeration Date | 01/02/2020 |
| Last Update Date | 06/09/2023 |
| Certification Date | 06/09/2023 |
| Medicare PECOS PAC ID | 4587001706 |
|---|---|
| Medicare Enrollment ID | O20240325000385 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487293858 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Tracy Lynn Doro-krueger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366774689 PECOS PAC ID: 5496192619 Enrollment ID: I20240325000448 |
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