Basic Information
| Provider Information | |||||||||
| NPI: | 1285366591 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOREST VIEW COUNSELING SERVICES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13925 CASSIDY DR | ||||||||
| Address2: | |||||||||
| City: | ROCKTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610721670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153910168 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6975 REDANSA DR | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611081201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153910168 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2022 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | GILLETTE | ||||||||
| AuthorizedOfficialFirstName: | COLIN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8153910168 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.