Healthcare Provider Details

I. General information

NPI: 1184183477
Provider Name (Legal Business Name): ANGILENE NICHOLE FORREST LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1768 MITCHELL RD STE 301
CERES CA
95307-2156
US

IV. Provider business mailing address

3700 MOORE RD
CERES CA
95307-6735
US

V. Phone/Fax

Practice location:
  • Phone: 209-353-4838
  • Fax:
Mailing address:
  • Phone: 209-735-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157613
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: