Provider Demographics
NPI:1881954691
Name:FORBERG, NICOLE JEANNINE (BA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JEANNINE
Last Name:FORBERG
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 HOBKIRKS PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5599
Mailing Address - Country:US
Mailing Address - Phone:719-433-5790
Mailing Address - Fax:
Practice Address - Street 1:1155 KELLY JOHNSON BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3932
Practice Address - Country:US
Practice Address - Phone:719-590-4124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health