Formation Counseling Center

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

FORMATION COUNSELING CENTER

Practice address

128 S Tejon St Ste 405
Colorado Springs, CO 80903-2212

Phone

(312) 369-9422

Fax

(719) 755-4662

NPI assigned

Jul 10, 2023

Organization subpart

No

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

Authorized official

Name

Alice Boertje, LCPC, NCC, LPCNPI 1205478468

Title

Founder, Therapist

Phone

(312) 369-9422

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 1

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

• Alice Anne Boertje, MA, LPC, NCC

  • Mental Health Counselor
  • Colorado Springs, CO
  • NPI 1205478468
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1194403238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 S TEJON ST STE 405",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809032212",
            "telephone_number": "312-369-9422",
            "fax_number": "719-755-4662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 S TEJON ST STE 405",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809032212",
            "telephone_number": "312-369-9422",
            "fax_number": "719-755-4662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORMATION COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-10",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "BOERTJE",
        "authorized_official_first_name": "ALICE",
        "authorized_official_title_or_position": "FOUNDER, THERAPIST",
        "authorized_official_telephone_number": "312-369-9422",
        "authorized_official_credential": "LCPC, NCC, LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Forget-Me-Not Comprehensive Care, LLC
• Forget-Me-Not Comprehensive Care, LLC
• Crystal Forget, LCSW, LAC
• Patricia Forget
• Kylie Forgrave
• Melissa B Fornara, MA CCC-SLP
• Jasie Forney
• Katharine Elizabeth Forney, PHARM.D.
• Nancy Marie Forney, LPC
• Vedette Forney

• Mental Health Counselor in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.