Provider Demographics
NPI:1972830982
Name:COSTENBADER, JANE FORSYTH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:FORSYTH
Last Name:COSTENBADER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:JANE
Other - Middle Name:FORSYTH
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2305 ARLINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4111
Mailing Address - Country:US
Mailing Address - Phone:205-933-9276
Mailing Address - Fax:205-933-9280
Practice Address - Street 1:2305 ARLINGTON AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4111
Practice Address - Country:US
Practice Address - Phone:205-933-9276
Practice Address - Fax:205-933-9289
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional