Provider Demographics
NPI:1790835890
Name:FORREST, CATHERINE RANDELL (MA, LLP)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:RANDELL
Last Name:FORREST
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4490 BIRCHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4804
Mailing Address - Country:US
Mailing Address - Phone:231-799-2323
Mailing Address - Fax:
Practice Address - Street 1:4490 BIRCHWOOD CT
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4804
Practice Address - Country:US
Practice Address - Phone:231-799-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009970103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301009970OtherLICENSE
MI0000019231OtherPRIORITY HEALTH
MI507110OtherCARE CHOICES