Provider Demographics
NPI:1326015603
Name:FORHETZ, JOHN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:FORHETZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2B MEADOW HEIGHTS PROFESIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4487
Mailing Address - Country:US
Mailing Address - Phone:618-344-7105
Mailing Address - Fax:618-344-2516
Practice Address - Street 1:2 MEADOW HEIGHTS PROFESIONAL PARK
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4487
Practice Address - Country:US
Practice Address - Phone:618-344-7105
Practice Address - Fax:618-344-2516
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002061103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical