Provider Demographics
NPI:1578198271
Name:RAY, FORREST S (LPCC)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:S
Last Name:RAY
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 EAGLE WAY APT 24
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1339
Mailing Address - Country:US
Mailing Address - Phone:850-748-4399
Mailing Address - Fax:
Practice Address - Street 1:1551 PROFESSIONAL LN UNIT 180
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6970
Practice Address - Country:US
Practice Address - Phone:720-476-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0017005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health