Provider Demographics
NPI:1205092004
Name:FORREST, JULIE M (LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:FORREST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:NOTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-4309
Mailing Address - Country:US
Mailing Address - Phone:228-300-8819
Mailing Address - Fax:601-401-4289
Practice Address - Street 1:213 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-4309
Practice Address - Country:US
Practice Address - Phone:228-300-8819
Practice Address - Fax:601-401-4289
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC7150101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018213Medicaid