Provider Demographics
NPI:1730844010
Name:FORAKER, ELLEN JULIET (LPC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:JULIET
Last Name:FORAKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2464
Mailing Address - Country:US
Mailing Address - Phone:555-555-5555
Mailing Address - Fax:
Practice Address - Street 1:420 COWPATH RD
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-2036
Practice Address - Country:US
Practice Address - Phone:267-203-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC012549Medicaid