Frank E Forthman, MDIV, QMHP

Key facts

NPI

1366646168

Entity type

Individual (NPI type 1)

Primary specialty

Mental Health Counselor 101YM0800X

Practice address

408 E Vine St
Vienna, IL 62995-1612

Phone

(618) 658-2611

NPI assigned

Jun 14, 2007

Sex

Male

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Counseling Center Community/Behavioral Health Agency · Vienna, IL · NPI 1356726707
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366646168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 METROPOLIS ST",
            "city": "METROPOLIS",
            "state": "IL",
            "postal_code": "629601308",
            "telephone_number": "618-524-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 E VINE ST",
            "city": "VIENNA",
            "state": "IL",
            "postal_code": "629951612",
            "telephone_number": "618-658-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTHMAN",
        "first_name": "FRANK",
        "middle_name": "E",
        "credential": "MDIV, QMHP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Vienna, IL · Mental Health Counselor in Illinois