Provider Demographics
NPI:1376941617
Name:FORSYTH, JANENE (LMFT)
Entity Type:Individual
Prefix:
First Name:JANENE
Middle Name:
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1191
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-1191
Mailing Address - Country:US
Mailing Address - Phone:831-234-2288
Mailing Address - Fax:
Practice Address - Street 1:5271 SCOTTS VALLEY DR STE 11
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3577
Practice Address - Country:US
Practice Address - Phone:831-234-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist