Provider Demographics
NPI:1073024725
Name:FORSYTH, EMMA M (LPC)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:M
Last Name:FORSYTH
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 1:11907 CONANN CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-2110
Mailing Address - Country:US
Mailing Address - Phone:512-797-5255
Mailing Address - Fax:
Practice Address - Street 1:314 E HIGHLAND MALL BLVD STE 252
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3766
Practice Address - Country:US
Practice Address - Phone:512-774-5779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-21
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health