1558345140 NPI number — DR. ALAN W. FORREST LPC, LMFT

Table of content: DR. ALAN W. FORREST LPC, LMFT (NPI 1558345140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558345140 NPI number — DR. ALAN W. FORREST LPC, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORREST
Provider First Name:
ALAN
Provider Middle Name:
W.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LPC, LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558345140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4656 BRAMBLETON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018-3437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-772-8043
Provider Business Mailing Address Fax Number:
540-772-8242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 COUNTRY CLUB DR SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24060-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-951-2227
Provider Business Practice Location Address Fax Number:
540-951-1144
Provider Enumeration Date:
12/06/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701001220 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 0717000476 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 176105 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".