Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 860797 | MI |
NPI | 1114970621 |
---|---|
Provider Name | Dr. Lennox Hugh Forrest |
First Address | Grand Rapids, MI 49501-1767 |
Second Address | Grand Rapids, MI 49503-4693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 25/10/2011 |