Provider Demographics
NPI:1376844050
Name:FORREST, STACY JORDAN (MA, LPC, NCC, CADC1)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:JORDAN
Last Name:FORREST
Suffix:
Gender:F
Credentials:MA, LPC, NCC, CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2211
Mailing Address - Country:US
Mailing Address - Phone:971-506-1885
Mailing Address - Fax:503-656-0649
Practice Address - Street 1:419 CENTER ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2211
Practice Address - Country:US
Practice Address - Phone:971-506-1885
Practice Address - Fax:503-656-0649
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2015-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health