NPIMap

Organization Active NPI

Forest City Counseling, LLC

  • Clinical Social Worker
  • Rockford, IL
National Provider Identifier
1164075990
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
FOREST CITY COUNSELING, LLC
Practice address
6735 Vistagreen Way Ste 210
Rockford, IL 61107-5654
Phone
(815) 391-3055
Fax
(815) 904-6419
NPI assigned
Jul 21, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jan M Selander, LCSWNPI 1396138350
Title
LCSW
Phone
(815) 520-6972

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Case Management Agency 251B00000X

Addresses

Primary practice location

6735 Vistagreen Way Ste 210
Rockford, IL 61107-5654

Mailing address

6735 Vistagreen Way Ste 210
Rockford, IL 61107-5654
Phone (815) 391-3055

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL http://www.simplepractice.com

National Provider Directory

National Provider Directory

Locations

6735 Vistagreen Way
Ste 210
Rockford, IL 61107
Phone (815) 391-3055

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681948800000",
    "number": "1164075990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6735 VISTAGREEN WAY STE 210",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075654",
            "telephone_number": "815-391-3055",
            "fax_number": "815-904-6419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6735 VISTAGREEN WAY STE 210",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075654",
            "telephone_number": "815-391-3055",
            "fax_number": "815-904-6419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST CITY COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-21",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A",
        "authorized_official_last_name": "SELANDER",
        "authorized_official_first_name": "JAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "LCSW",
        "authorized_official_telephone_number": "815-520-6972",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://www.simplepractice.com",
            "affiliation": "N",
            "address_1": "7294 Argus Dr",
            "city": "Rockford",
            "state": "IL",
            "country_code": "US",
            "postal_code": "611075837",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.