Provider Demographics
NPI:1700321791
Name:FORSYTH, CASEY (CASAC, SUDP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:CASAC, SUDP
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:MONAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:808 SHERMAN ST NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4830
Mailing Address - Country:US
Mailing Address - Phone:607-345-0503
Mailing Address - Fax:
Practice Address - Street 1:235 S 3RD ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2255
Practice Address - Country:US
Practice Address - Phone:360-426-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61016510101YA0400X
NY2306101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)