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NPI Code Detail

MEDICARE: MISS NICOLE RAE FORSYTH AMFT 128339

MEDICARE: MISS NICOLE RAE FORSYTH AMFT 128339
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist128339CA

General Provider Information

NPI Number : 1952776403
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS NICOLE RAE FORSYTH AMFT 128339
Provider Business Mailing Address
First Line : 1396 W HERNDON AVE # SUT110
Second Line :
City : FRESNO
State : CA
Zip : 93711-7126
Country : US
Telephone Number : 559-256-0100
Fax Number :
Provider Business Practice Location Address
First Line : 1396 W HERNDON AVE # SUT110
Second Line :
City : FRESNO
State : CA
Zip : 93711-7126
Country : US
Telephone Number : 559-256-0100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2015
Last Update Date : 06/23/2023

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