Provider Demographics
NPI:1790771251
Name:FORSYTH CARTER, SHERRY LYNN (MC, LPC)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:FORSYTH CARTER
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:LYNN
Other - Last Name:BURK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17999 TREGONING LN
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-8326
Mailing Address - Country:US
Mailing Address - Phone:480-888-6223
Mailing Address - Fax:
Practice Address - Street 1:4435 E BROADWAY RD STE 3
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2012
Practice Address - Country:US
Practice Address - Phone:480-888-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZLPC -1730101YP2500X
AZ4906101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health