Provider Demographics
NPI:1932402765
Name:FORAGE, TOMMIE K (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TOMMIE
Middle Name:K
Last Name:FORAGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 S DURANGO DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-0191
Mailing Address - Country:US
Mailing Address - Phone:702-726-0709
Mailing Address - Fax:702-248-2008
Practice Address - Street 1:5145 S DURANGO DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0191
Practice Address - Country:US
Practice Address - Phone:702-726-0709
Practice Address - Fax:702-248-2008
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5773C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical