Provider Demographics
NPI:1417243312
Name:FORREST, AMBER ANN
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:ANN
Last Name:FORREST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:ANN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26970 S INDIAN RD
Mailing Address - Street 2:
Mailing Address - City:PARK HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74451-2006
Mailing Address - Country:US
Mailing Address - Phone:918-931-8852
Mailing Address - Fax:
Practice Address - Street 1:26970 S INDIAN RD
Practice Address - Street 2:
Practice Address - City:PARK HILL
Practice Address - State:OK
Practice Address - Zip Code:74451-2006
Practice Address - Country:US
Practice Address - Phone:918-931-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor