Provider Demographics
NPI:1417188541
Name:FORBES, DOREEN KELLY (LCPC)
Entity Type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:KELLY
Last Name:FORBES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-2015
Mailing Address - Country:US
Mailing Address - Phone:618-960-4174
Mailing Address - Fax:
Practice Address - Street 1:6209 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-2015
Practice Address - Country:US
Practice Address - Phone:618-960-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.001719101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional