Provider Demographics
NPI:1528604378
Name:FORBES, SHAWN L (LCPC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:L
Last Name:FORBES
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N MAIN ST STE 104B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1755
Mailing Address - Country:US
Mailing Address - Phone:314-762-1480
Mailing Address - Fax:
Practice Address - Street 1:207 N MAIN ST STE 104B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1755
Practice Address - Country:US
Practice Address - Phone:314-762-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional