Provider Demographics
NPI:1184256869
Name:FORRISTEL, TERRA MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:MICHELLE
Last Name:FORRISTEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERRA
Other - Middle Name:MICHELLE
Other - Last Name:HALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13822 BOSC DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8506
Mailing Address - Country:US
Mailing Address - Phone:530-228-4692
Mailing Address - Fax:
Practice Address - Street 1:1430 EAST AVE STE 4A
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1629
Practice Address - Country:US
Practice Address - Phone:530-514-0294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CA1022961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical