Provider Demographics
NPI:1235474180
Name:FORBES, DAVID LEE (LCPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:FORBES
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S DURKIN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6029
Mailing Address - Country:US
Mailing Address - Phone:217-726-7575
Mailing Address - Fax:217-726-7577
Practice Address - Street 1:701 S DURKIN DR
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6029
Practice Address - Country:US
Practice Address - Phone:217-726-7575
Practice Address - Fax:217-726-7577
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.005824101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional