Provider Demographics
NPI:1386896678
Name:FORCIER, CHARLENE ANN (MS, LMFT)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ANN
Last Name:FORCIER
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:ANN
Other - Last Name:WORM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:600 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2102
Mailing Address - Country:US
Mailing Address - Phone:952-361-1640
Mailing Address - Fax:952-361-1660
Practice Address - Street 1:303 E 6TH ST
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2103
Practice Address - Country:US
Practice Address - Phone:612-280-5075
Practice Address - Fax:952-361-1660
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist