Provider Demographics
NPI:1851973127
Name:FORESTAL, JANNELL LYNN
Entity Type:Individual
Prefix:
First Name:JANNELL
Middle Name:LYNN
Last Name:FORESTAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANNELL
Other - Middle Name:LYNN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 E COLORADO BLVD STE 560
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2380
Mailing Address - Country:US
Mailing Address - Phone:818-241-6780
Mailing Address - Fax:818-241-6853
Practice Address - Street 1:160 CLAIREMONT AVE STE 625
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2541
Practice Address - Country:US
Practice Address - Phone:818-241-6730
Practice Address - Fax:818-241-6853
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician