Provider Demographics
NPI:1639489412
Name:FORREST, GARY MILES (LMFT, SAP)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MILES
Last Name:FORREST
Suffix:
Gender:M
Credentials:LMFT, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334
Mailing Address - Country:US
Mailing Address - Phone:954-308-7479
Mailing Address - Fax:954-337-0530
Practice Address - Street 1:120 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:954-308-7479
Practice Address - Fax:955-337-0530
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20696101YA0400X
FLMT2443106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty