Provider Demographics
NPI:1548573496
Name:FORRESTER, KELLY ANNE-JULIN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE-JULIN
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 VETERANS DR STE 126
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4564
Mailing Address - Country:US
Mailing Address - Phone:231-735-8338
Mailing Address - Fax:833-704-6170
Practice Address - Street 1:3301 VETERANS DR STE 126
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4564
Practice Address - Country:US
Practice Address - Phone:231-735-8338
Practice Address - Fax:833-704-6170
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012209101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty