Provider Demographics
NPI:1558110189
Name:FOREVER BECOMING LLC
Entity type:Organization
Organization Name:FOREVER BECOMING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHCA
Authorized Official - Phone:312-248-4062
Mailing Address - Street 1:12125 E 65TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-4653
Mailing Address - Country:US
Mailing Address - Phone:312-248-4062
Mailing Address - Fax:
Practice Address - Street 1:1315 LEMANS CT APT 702
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1211
Practice Address - Country:US
Practice Address - Phone:312-248-4062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty