Provider Demographics
NPI:1336798990
Name:FOREST CREEK COUNSELING LLC
Entity type:Organization
Organization Name:FOREST CREEK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-731-9704
Mailing Address - Street 1:496 SHAYLA LN
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133
Mailing Address - Country:US
Mailing Address - Phone:512-731-9704
Mailing Address - Fax:866-278-0186
Practice Address - Street 1:496 SHAYLA LN
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133
Practice Address - Country:US
Practice Address - Phone:512-731-9704
Practice Address - Fax:866-278-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX071331502Medicaid