Provider Demographics
NPI:1174584841
Name:FORREST, DAVID (LPHD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:FORREST
Suffix:
Gender:M
Credentials:LPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7914 DENSMORE AVE N, APT 306
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4948
Mailing Address - Country:US
Mailing Address - Phone:206-525-5039
Mailing Address - Fax:
Practice Address - Street 1:7914 DENSMORE AVE N APT 306
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4948
Practice Address - Country:US
Practice Address - Phone:206-525-5039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY.00003934103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8873693Medicare PIN