Ellen Juliet Foraker, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC012549 Issued in PA

Practice address

420 Cowpath Rd
Souderton, PA 18964-2036

Phone

(267) 203-1500

NPI assigned

Nov 2, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Indian Creek Foundation

  • Community/Behavioral Health Agency
  • Souderton, PA
  • NPI 1023163854
  NPD

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

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1730844010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 E ANDERSON AVE",
            "city": "PHOENIXVILLE",
            "state": "PA",
            "postal_code": "194602464",
            "telephone_number": "555-555-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 COWPATH RD",
            "city": "SOUDERTON",
            "state": "PA",
            "postal_code": "189642036",
            "telephone_number": "267-203-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORAKER",
        "first_name": "ELLEN",
        "middle_name": "JULIET",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-02",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC012549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PC012549",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.indcreek.org",
            "affiliation": "Y",
            "affiliationName": "INDIAN CREEK FOUNDATION",
            "address_1": "420 Cowpath Rd",
            "city": "Souderton",
            "state": "PA",
            "country_code": "US",
            "postal_code": "189642036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Professional Counselor in Souderton, PA
• Providers in Souderton, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.