Active NPI
Jere Dee Forman, LPC-SUPERVISOR
- Professional Counselor
- Allen, TX
National Provider Identifier
1821435330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 60025
- Practice address
- 1333 McDermott Drive
200
Allen, TX 75013-3089 - Phone
- (469) 371-5766
- NPI assigned
- May 24, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 60025 | TX | Primary |
Addresses
Primary practice location
1333 McDermott Drive
200
Allen, TX 75013-3089
Mailing address
1333 McDermott Drive
200
Allen, TX 75013-3089
Phone (469) 371-5766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 30, 2024 through Jan 30, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369353600000",
"number": "1821435330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1333 MCDERMOTT DRIVE",
"address_2": "200",
"city": "ALLEN",
"state": "TX",
"postal_code": "750133089",
"telephone_number": "469-371-5766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1333 MCDERMOTT DRIVE",
"address_2": "200",
"city": "ALLEN",
"state": "TX",
"postal_code": "750133089",
"telephone_number": "469-371-5766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMAN",
"first_name": "JERE",
"middle_name": "DEE",
"credential": "LPC-SUPERVISOR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-24",
"last_updated": "2013-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "60025",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Allen, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.