Provider Demographics
NPI:1912369638
Name:FORREST, KYLE M (LMHC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:M
Last Name:FORREST
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:FORREST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:3123 FAIRVIEW AVE E.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102
Mailing Address - Country:US
Mailing Address - Phone:206-619-2459
Mailing Address - Fax:
Practice Address - Street 1:3123 FAIRVIEW AVE E.
Practice Address - Street 2:SUITE 204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102
Practice Address - Country:US
Practice Address - Phone:206-619-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006840101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health