Provider Demographics
NPI:1225494602
Name:FORRISTER, SKYLAR STUART II (MA)
Entity Type:Individual
Prefix:MR
First Name:SKYLAR
Middle Name:STUART
Last Name:FORRISTER
Suffix:II
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 NW FRANKLIN AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2752
Mailing Address - Country:US
Mailing Address - Phone:541-306-1128
Mailing Address - Fax:
Practice Address - Street 1:731 NW FRANKLIN AVE STE 107
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2752
Practice Address - Country:US
Practice Address - Phone:541-306-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health