Provider Demographics
NPI:1720594260
Name:FORBES, SEAN (LLMSW, DP-C, CPRC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:FORBES
Suffix:
Gender:M
Credentials:LLMSW, DP-C, CPRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1879
Mailing Address - Country:US
Mailing Address - Phone:810-858-9317
Mailing Address - Fax:
Practice Address - Street 1:3111 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-8127
Practice Address - Country:US
Practice Address - Phone:810-985-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511165951041C0700X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical