Forevermore Mind Body & Soul

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

FOREVERMORE MIND BODY & SOUL

Practice address

411 N Bluff St Apt 11
Joliet, IL 60435-7295

Phone

(815) 766-5999

NPI assigned

Aug 29, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Demitrius Brackett, PAINNPI 1053911479

Title

Mental Health Provider

Phone

(815) 766-5999

Specialties & licenses 6

Addresses

Other names 1

• Forevermore Healthcare Doing business as

Locations

Practitioners 1

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

• Demitrius Brackett, OWNER/DO

  • Cognitive & Behavioral Psychologist
  • Joliet, IL
  • NPI 1053911479

  Meals

  NPD Authorized official

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

{
    "created_epoch": "1693267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764720000000",
    "number": "1346025285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 N BLUFF ST APT 11",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604357295",
            "telephone_number": "815-766-5999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 N BLUFF ST APT 11",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604357295",
            "telephone_number": "815-766-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREVERMORE MIND BODY & SOUL",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-29",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A",
        "authorized_official_last_name": "BRACKETT",
        "authorized_official_first_name": "DEMITRIUS",
        "authorized_official_title_or_position": "MENTAL HEALTH PROVIDER",
        "authorized_official_telephone_number": "815-766-5999",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PAIN"
    },
    "taxonomies": [
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Research",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forevermore Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Forevermore Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• FMK Medical Corporation
• Kathleen L Foley, LCSW
• Mark Fonseca
• Talia Sarai Fontanetta
• Morgan Ashley Foreman
• Allison Renee Fortier, PHARMD
• Fostering Hope of Illinois
• Jessica Lynn Fouch, B.S.
• Michelle Fouche, PA-C
• James Bryan Fountain II, PTA

• Clinic/Center in Joliet, IL
• Providers in Joliet, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2025; 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.