Provider Demographics
NPI:1700428976
Name:FORNOS, DAVID JAMES (LMFT-A, LPC-I)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:FORNOS
Suffix:
Gender:M
Credentials:LMFT-A, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 WOODWARD ST APT 215
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-7819
Mailing Address - Country:US
Mailing Address - Phone:210-200-9469
Mailing Address - Fax:
Practice Address - Street 1:7004 BEE CAVES RD
Practice Address - Street 2:UNIT 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5004
Practice Address - Country:US
Practice Address - Phone:512-306-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81376101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health