Provider Demographics
NPI:1053981605
Name:FORWARD THERAPEUTICS LLC
Entity type:Organization
Organization Name:FORWARD THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUCKEIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:937-367-4614
Mailing Address - Street 1:118 W 1ST ST STE 308
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1150
Mailing Address - Country:US
Mailing Address - Phone:937-443-7659
Mailing Address - Fax:855-978-1771
Practice Address - Street 1:118 W 1ST ST STE 308
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1150
Practice Address - Country:US
Practice Address - Phone:937-443-7659
Practice Address - Fax:855-978-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-27
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty