Provider Demographics
NPI:1114970621
Name:FORREST, LENNOX HUGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:LENNOX
Middle Name:HUGH
Last Name:FORREST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:MR
Other - First Name:LENNOX
Other - Middle Name:HUGH
Other - Last Name:FORREST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1767
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-1767
Mailing Address - Country:US
Mailing Address - Phone:616-235-2090
Mailing Address - Fax:616-235-2099
Practice Address - Street 1:310 LAFAYETTE AVE SE
Practice Address - Street 2:SUITE 325
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4693
Practice Address - Country:US
Practice Address - Phone:616-249-8486
Practice Address - Fax:616-456-7559
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI860797103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling