Provider Demographics
NPI:1295065860
Name:FORRY, KETRA A (BA)
Entity type:Individual
Prefix:
First Name:KETRA
Middle Name:A
Last Name:FORRY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:KETRA
Other - Middle Name:
Other - Last Name:BITTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-5040
Mailing Address - Country:US
Mailing Address - Phone:717-272-5464
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:445 GETTYSBURG PIKE
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5169
Practice Address - Country:US
Practice Address - Phone:717-795-8363
Practice Address - Fax:717-796-1466
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
PAPC008070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst