Provider Demographics
NPI:1346304177
Name:YANKE, FORREST STEWART (LMFT, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:FORREST
Middle Name:STEWART
Last Name:YANKE
Suffix:
Gender:F
Credentials:LMFT, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 FORTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-1831
Mailing Address - Country:US
Mailing Address - Phone:850-769-6188
Mailing Address - Fax:850-769-1261
Practice Address - Street 1:1103 FORTUNE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1831
Practice Address - Country:US
Practice Address - Phone:850-769-6188
Practice Address - Fax:850-769-1261
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW3681041C0700X
FLMT216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1199OtherBLUE CROSS BLUE SHIELD
FLZ1199Medicare ID - Type Unspecified