Provider Demographics
NPI:1912288879
Name:JACKSON FORBES, KAREN MARIE (MS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:JACKSON FORBES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 E MADISON ST
Mailing Address - Street 2:#212
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4749
Mailing Address - Country:US
Mailing Address - Phone:206-323-5510
Mailing Address - Fax:
Practice Address - Street 1:2711 E MADISON ST
Practice Address - Street 2:#212
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4749
Practice Address - Country:US
Practice Address - Phone:206-323-5510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006525101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health