Provider Demographics
NPI:1609652718
Name:FORGETTE, JUSTIN W (LPC MHSP)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:W
Last Name:FORGETTE
Suffix:
Gender:M
Credentials:LPC MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10198 FIELDING RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6402
Mailing Address - Country:US
Mailing Address - Phone:423-994-2552
Mailing Address - Fax:
Practice Address - Street 1:10198 FIELDING RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363
Practice Address - Country:US
Practice Address - Phone:423-994-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3237101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional