Provider Demographics
NPI:1073269163
Name:DYKES, FORREST TAYLOR (LMHC)
Entity Type:Individual
Prefix:MR
First Name:FORREST
Middle Name:TAYLOR
Last Name:DYKES
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-7726
Mailing Address - Country:US
Mailing Address - Phone:561-578-3647
Mailing Address - Fax:
Practice Address - Street 1:1900 S OLIVE AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7726
Practice Address - Country:US
Practice Address - Phone:561-578-3647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-27
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19031101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty