NPIMap

Organization Active NPI

Forming Friendships LLC

  • Community/Behavioral Health Agency
  • Hillsboro, MO
National Provider Identifier
1396257408
Registry record updated Mar 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
2015044940 Issued in MO
Legal business name
FORMING FRIENDSHIPS LLC
Practice address
171 Roberts Dr
Hillsboro, MO 63050-4120
Phone
(314) 297-0793
Fax
(314) 202-5441
NPI assigned
Oct 30, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2019

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

Authorized official

Name
Katherine A Petefish, LCPC, BCBA, LBANPI 1487096012
Title
Owner/Behavior Analyst
Phone
(314) 297-0793

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 2015044940 MO Primary

Addresses

Primary practice location

171 Roberts Dr
Hillsboro, MO 63050-4120

Mailing address

171 Roberts Dr
Hillsboro, MO 63050-4120

Other identifiers 1

IdentifierTypeStateIssuer
500052076MedicaidMO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552435200000",
    "number": "1396257408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 ROBERTS DR",
            "city": "HILLSBORO",
            "state": "MO",
            "postal_code": "630504120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 ROBERTS DR",
            "city": "HILLSBORO",
            "state": "MO",
            "postal_code": "630504120",
            "telephone_number": "314-297-0793",
            "fax_number": "314-202-5441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORMING FRIENDSHIPS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-30",
        "last_updated": "2019-03-13",
        "status": "A",
        "authorized_official_last_name": "PETEFISH",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/BEHAVIOR ANALYST",
        "authorized_official_telephone_number": "314-297-0793",
        "authorized_official_credential": "LCPC, BCBA, LBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MO",
            "license": "2015044940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500052076",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hillsboro, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; 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.