Provider Demographics
NPI:1912133075
Name:FORRESTER, SARAH R (LPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5956 E PIMA ST
Mailing Address - Street 2:#130
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4375
Mailing Address - Country:US
Mailing Address - Phone:520-784-3421
Mailing Address - Fax:520-296-8157
Practice Address - Street 1:5956 E PIMA ST
Practice Address - Street 2:#130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4375
Practice Address - Country:US
Practice Address - Phone:520-784-3421
Practice Address - Fax:520-296-8157
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC10560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC10560OtherLICENSE