Provider Demographics
NPI:1164756771
Name:FORSMAN, MONICA (LCMHC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:FORSMAN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 CHARLAIS DR
Mailing Address - Street 2:
Mailing Address - City:FRUIT HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84037-3633
Mailing Address - Country:US
Mailing Address - Phone:801-604-5040
Mailing Address - Fax:
Practice Address - Street 1:1355 N MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5982
Practice Address - Country:US
Practice Address - Phone:801-259-3883
Practice Address - Fax:801-295-4201
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7686687-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health