Provider Demographics
NPI:1013495043
Name:JOAN MCPHERSON FOREST I
Entity Type:Organization
Organization Name:JOAN MCPHERSON FOREST I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOREST
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:360-969-5583
Mailing Address - Street 1:2620 DREAMLAND LN
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-8108
Mailing Address - Country:US
Mailing Address - Phone:360-969-5583
Mailing Address - Fax:360-246-9218
Practice Address - Street 1:390 NE MIDWAY BLVD STE B206A
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2642
Practice Address - Country:US
Practice Address - Phone:360-969-5583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty