Provider Demographics
NPI:1477653145
Name:FORSYTH, ANDREW B (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:FORSYTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 S MAPLE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3445
Mailing Address - Country:US
Mailing Address - Phone:509-353-9885
Mailing Address - Fax:509-353-9886
Practice Address - Street 1:628 S MAPLE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3445
Practice Address - Country:US
Practice Address - Phone:509-353-9885
Practice Address - Fax:509-353-9886
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1912103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical