Provider Demographics
NPI:1629418363
Name:ZACHARIAS FORSYTH, SHERRY MELENA (CADC II, CGAC II)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:MELENA
Last Name:ZACHARIAS FORSYTH
Suffix:
Gender:F
Credentials:CADC II, CGAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MAIN ST.
Mailing Address - Street 2:NEW DIRECTIONS
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814
Mailing Address - Country:US
Mailing Address - Phone:541-523-8364
Mailing Address - Fax:
Practice Address - Street 1:2100 MAIN ST.
Practice Address - Street 2:NEW DIRECTIONS
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814
Practice Address - Country:US
Practice Address - Phone:541-523-8364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10-03-43101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)