Provider Demographics
NPI:1952517575
Name:FORISHA, BILLIE EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:BILLIE
Middle Name:EDWARD
Last Name:FORISHA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 NORTHROP DR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3657
Mailing Address - Country:US
Mailing Address - Phone:206-661-6918
Mailing Address - Fax:
Practice Address - Street 1:4715 NORTHROP DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3657
Practice Address - Country:US
Practice Address - Phone:206-661-6918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2009-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPO 929103TC1900X
WALF00001275106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist